m icrocuff * pediatric endotracheal tubes
DESCRIPTION
M ICROCUFF * Pediatric Endotracheal Tubes. Finally, a cuffed ET tube designed for the pediatric anatomy. Issues with uncuffed tubes. Airway leak. Pressure on cricoid. Too small a tube - difficult ventilation 1,2. 3.0mm. 3.5mm. 4.0mm. Too large a tube - PowerPoint PPT PresentationTRANSCRIPT
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