ORIGINAL ARTICLE   

Minerva Anestesiologica 2022 November;88(11):890-900

DOI: 10.23736/S0375-9393.22.16293-0

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Association between cuffed tracheal tube use and reduced ventilator-associated pneumonia and conditions after elective cardiac surgery in infants and young children

Mirco NACOTI ¹ ✉, Alessandra CAROBBIO ², Stefano FINAZZI ³, Isabella PELLICIOLI ¹, Francesco CONSONNI ¹, Floriana FERRARI ¹, Moreno FAVARATO ¹, Francesco FAZZI ¹, Ezio BONANOMI ¹

¹ Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Papa Giovanni XXIII Hospital, Bergamo, Italy; ² FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy; ³ Department of Clinical Epidemiology, Mario Negri IRCCS Pharmacological Research Institute, Ranica, Bergamo, Italy

BACKGROUND: Ventilator-associated pneumonia (VAP) is a serious complication in children after cardiac surgery that may result from micro-aspiration. However, the current recommendation to use cuffed tracheal tubes (TTs) versus uncuffed TTs in children is still uncertain. Our main aim was to evaluate the incidence of VAP, ventilator-associated tracheobronchitis (VAT) and ventilator-associated conditions (VAC) in children up to five years old who underwent elective cardiac surgery.
METHODS: Single-center, prospective before-and-after study at a tertiary pediatric intensive care unit (PICU) in Italy. 242 patients (121 in each group) through the following periods: phase I (from Jan 2017 to 20^th Feb 2018), during which children were intubated with uncuffed TTs; phase II (from 21^th Feb 2018 to Feb 2019), during which children were intubated with cuffed TTs.
RESULTS: Data were collected using an electronic dedicated database. Median age was five months. The use of cuffed tubes reduced the risk of VAC and VAP respectively 15.8 times (95% CI 3.4-73.1, P=0.0008) and 14.8 times (95% CI 3.1-71.5, P=0.002). No major related airway complications were observed in the cuffed TTs group. Average treatment effect, calculated after propensity score matching, confirmed the significant effect of cuffed TTs on VAC and VAP.
CONCLUSIONS: Our study suggests a marked reduction of VAP and VAC associated with use of a cuffed versus uncuffed TT in infants and children ≤5 years of age after elective cardiac surgery. A randomized clinical trial is needed to confirm these results and define the impact of use of a cuffed versus uncuffed TT across other relevant ICU outcomes and non-cardiac PICU patients.

KEY WORDS: Cardiac surgical procedures; Pediatrics; Trachea; Pneumonia, ventilator-associated