Kimberly-Clark* MICROCUFF* Endotracheal Tubes

Finally, a cuffed ET tube designed for the pediatric anatomy

MICROCUFF* Pediatric Endotracheal TubesMICROCUFF* Pediatric Endotracheal Tubes

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewIssues with uncuffed tubes

Too small a tube- difficult ventilation1,2

1Fine, Borland. Pediatric Anesthesia, 20042Stocks JG. BMJ, 1966

3.0mm 3.5mm 4.0mm

Pressure on cricoidAirway leak

Fig: Gerber AC, SPANZA, 2007.

Too large a tube

- higher risk of subglottic stenosis1,2

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewSealing Differences With Uncuffed Tubes

Suominen P et al. Paediatric Anaesthesia, 2006.Holzki J. Paediatric Anaesthesia, 1997.Weiss and Gerber. Pediatric Anesthesia, 2006.

Carina

Crocoid

Glottis

Inaccurate monitoring

Higher risk of aspiration

Difficult ventilation

Higher gas flow rate

Undersized Tubes Oversized Tubes

2.8 times more likely to develop adverse events

Primary cause (92%) for laryngeal trauma in a 65 patient study

Air Leak

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewIdeal Placement & Features of Cuffed Pediatric Tubes

Short, cylindrical cuff placed near the

tracheal tube tip

Cuff placement in the trachea, not in

the pressure-sensitive larynx

Anatomically-based depth mark

results in correct placement

Tip should rest mid-trachea to avoid

endobronchial tip migration

Low cuff pressure to reduce risk of

airway trauma

Carina

Crocoid

Glottis

Mid-Trachea

Proper cuffposition

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewMany cuffed ET tubes have an inappropriate design for pediatric use Too high cuff position, too long cuffs

Absent or unreliable depth marks

No reliable size selection recommendations

Cuff position should avoid pressure-sensitive vocal cords and cricoid ring

Weiss M, et al. British Journal of Anaesthesia, 2004.

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewThe Solution:KIMBERLY-CLARK* MICROCUFF* ET Tube

Finally, a cuffed ET tube specifically designedfor the pediatric anatomy

Finally, a cuffed ET tube specifically designedfor the pediatric anatomy

Superior seal at ultra-low pressures

Superior seal at ultra-low pressures

Confidence in a sealed airway

Confidence in a sealed airway

Short, distally-placed cuff

Short, distally-placed cuff

Ensures correct placement, avoiding repeated intubations

Ensures correct placement, avoiding repeated intubations

Dullenkopf A et al. Pediatric Anesthesia, 2004.

Introducing a microthin

polyurethane cuff

Introducing a microthin

polyurethane cuff

Clinically verified, anatomically correct vocal

cord depth mark

Clinically verified, anatomically correct vocal

cord depth mark

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewMICROCUFF* is designed for ideal anatomical cuff placement in the pediatric airway

Short, cylindrical cuff near tracheal tube tip

Correct intubation depth mark

Reduces risk of endobronchial intubation

“Depth marks of the new MICROCUFF* paediatric tracheal tube allow adequate placing of the tracheal tube with a cuff-free

subglottic zone and without the risk for endobronchial intubation in children from birth to adolescence.”

“Depth marks of the new MICROCUFF* paediatric tracheal tube allow adequate placing of the tracheal tube with a cuff-free

subglottic zone and without the risk for endobronchial intubation in children from birth to adolescence.”

Weiss, et al. British Journal of Anaesthesia, 2005.

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

Overview

“This preliminary investigation suggests that the new MICROCUFF* pediatric tube with ultra-thin high volume-low pressure cuff membrane

allows effective tracheal sealing at very low cuff pressures.”

“This preliminary investigation suggests that the new MICROCUFF* pediatric tube with ultra-thin high volume-low pressure cuff membrane

allows effective tracheal sealing at very low cuff pressures.”

Advanced microthin polyurethane cuff seals the airway at ultra-low pressure

Median cuff pressure. n=4x20 patients. Patient ages 2-4 yrs. Tube ID 4.0mm.

Capillary perfusion pressure in adults is 25-30 cm H2O; considered lower in pediatrics

Capillary perfusion pressure in adults is 25-30 cm H2O; considered lower in pediatrics

Fig: Dullenkopf et al. Pediatric Anesthesia, 2004. Median cuff pressure to seal the trachea in children aged 2-4 (n=4x20 patients, tube ID 4.0mm).

Dullenkopf A et al. Pediatric Anesthesia, 2004.

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewMICROCUFF* Endotracheal Tubes provide confidence in a sealed airway

Seals with a cuff, not a rigid tube shaft in the cricoid

Low rate of tube exchange

Positive pressure ventilation with sealed airway

Ensures reliable end-tidal CO2 monitoring

Reduced risk of aspiration of blood and secretions

Low gas flow rates

Dullenkopf, et al. Acta Anaesthesiologica Scandinavica, 2005.

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewMICROCUFF* ET tubes allow for safe tracheal intubation and sealing in children

500 patient study

Only 1.6% had to be reintubated due to incorrect tube size

Only 0.4% experienced post extubation croup requiring short term therapy

“The thin-walled polyurethane cuff membrane provides tracheal sealing at lower cuff pressure than reported, probably

contributing to the low incidence of postextubation croup.”15

“The thin-walled polyurethane cuff membrane provides tracheal sealing at lower cuff pressure than reported, probably

contributing to the low incidence of postextubation croup.”15

Dullenkopf, et al. Acta Anaesthesiologica Scandinavica, 2005.

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

OverviewEvidence-Based Positive Clinical Outcomes

Prospective Randomized Multi-Center Study

24 centers across Europe: n = 2,249 patients

Avg patient age of 1.9 years (3.0mm-4.5mm tubes used)

Tube exchange: 2.1% MICROCUFF, 29.9% uncuffed tubes

Post-extubation stridor: 4.38% MICROCUFF, 4.69% uncuffed tubes

Cuff pressure to seal the trachea: 10.6 cm H2O

Source: ad Swiss Med Wkly 2008:138 (41-42), October 18, 2008

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

Overview

"MICROCUFF* allowed safe positioning of the tube cuff and tube tip in almost all children investigated when placed with the

tracheal tube bend at the lower incisors or alveolar ridge.”

"MICROCUFF* allowed safe positioning of the tube cuff and tube tip in almost all children investigated when placed with the

tracheal tube bend at the lower incisors or alveolar ridge.”

MICROCUFF* RAE tubes are clinically verified

n = 166 patients

97% depth mark was positioned at or below vocal cords

100% tube tip remained above carina

100% correct tube size selection

Weiss, M, et al. British Journal of Anaesthesia, 2006.

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

Overview

MICROCUFF Pediatric – Top Clinical ArticlesArticle Title Author Publication PUBMED

Reference Number

MICROCUFF PEDIATRIC ET TUBE

Fit and Seal Characteristics of a New Paediatric Tracheal Tube with High-Volume Low-Pressure Polyurethane Cuff

Dullenkopf, et al. Acta Anaesthesiol Scand 2005; 49:232-237

15715626

Cuffed tracheal tubes in children – things have changed, Editorial

Weiss, et al. Pediatric Anesthesia 2006; 16:1005-1007

16972827

Tracheal Sealing Characteristics of Pediatric Cuffed Tracheal Tubes

Dullenkopf, et al. Pediatric Anesthesia 2004; 14:825-830

15385010

Appropriate Placement of Intubation Depth Marks in a New Cuffed Paediatric Tracheal Tube

Weiss, et al. British Journal of Anaesthesia 2005; 94:80-7

15486002

Intubation Depth Markings Allow an Improved Positioning of Endotracheal Tubes in Children

Weiss, et al. Can J Anesth 2005; 52:721-726

16103385

Clinical evaluation of cuff and tube tip position in a newly designed paediatric preformed oral cuffed tracheal tube

Weiss, et al. Br J Anaesth 2006; 97: 695-700

16984952

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

Overview

MICROCUFF ET tubes offer cost benefits

“… the increased costs for a cuffed paediatric tracheal tube are more than outweighed alone by savings in Sevorane consumption.”1

“… the increased costs for a cuffed paediatric tracheal tube are more than outweighed alone by savings in Sevorane consumption.”1

1Schmitz et al. Euroanesthesia (ESA) Congress, Munich 2007.* Translated from Euros to Dollars using Apr 2009 exchange rate 1Eu=1.3 Dollar** Not statistically different

Cost Item Measurement Uncuffed MICROCUFF

Tube Exchange Rate 30% 2%

Tube replacement Added $/patient $0.75 $0.15

Anesthesia Gas Savings (example: Sevoflorane)1

Duration of anesthesia min 57.7** 66.5**

Fresh gas flow Lt/min 2.45 0.95

Sevo costs per patient $/patient $19.24* $6.59*

Total Costs $19.99 $6.74

Cost Savings With MICROCUFF $13.25

Study by Schmitz compared MICROCUFF * tubes to Sheridan uncuffed tubes

MICROCUFF* Endotracheal Tubes

CONTENTS

Traditional Practice

Uncuffed Tube Shortcomings

Solution: MICROCUFF*

Cuffed Tube Benefits

Clinical Evidence

Summary

OrderingInformation

Best Practice

Cuffed Tube Concerns

References

Overview

Sizes Availabl

e

Recommended Size

Selection Chart