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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

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M ICROCUFF * Pediatric Endotracheal Tubes

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M icrocuff pediatric endotracheal tubes l.jpg

MICROCUFF*Pediatric Endotracheal Tubes

Finally, a cuffed ET tube designed for the pediatric anatomy


Issues with uncuffed tubes l.jpg

Issues with uncuffed tubes

Airway leak

Pressure on cricoid

Too small a tube

- difficult ventilation1,2

3.0mm

3.5mm

4.0mm

Too large a tube

- higher risk of subglottic stenosis1,2

Fig: Gerber AC, SPANZA, 2007.

1Fine, Borland. Pediatric Anesthesia, 2004

2Stocks JG. BMJ, 1966


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Sealing Differences With Uncuffed Tubes

Air Leak

  • Inaccurate monitoring

  • Higher risk of aspiration

  • Difficult ventilation

  • Higher gas flow rate

Undersized Tubes

Oversized Tubes

Glottis

  • 2.8 times more likely to develop adverse events

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

Crocoid

Carina

Suominen P et al. Paediatric Anaesthesia, 2006.

Holzki J. Paediatric Anaesthesia, 1997.

Weiss and Gerber. Pediatric Anesthesia, 2006.


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Ideal 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

Glottis

Proper cuff

position

Crocoid

Mid-Trachea

Carina


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Many 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.


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The Solution:KIMBERLY-CLARK* MICROCUFF* ET Tube

Confidence in a sealed airway

Introducing a microthin polyurethane cuff

Superior seal at ultra-low pressures

Short, distally-placed cuff

Ensures correct placement, avoiding repeated intubations

Clinically verified, anatomically correct vocal cord depth mark

Finally, a cuffed ET tube specifically designed

for the pediatric anatomy

Dullenkopf A et al. Pediatric Anesthesia, 2004.


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MICROCUFF* 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 newMICROCUFF*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.


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

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).

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

“This preliminary investigation suggests that the newMICROCUFF*pediatric tube with ultra-thin high volume-low pressure cuff membrane allows effective tracheal sealing at very low cuff pressures.”

Dullenkopf A et al. Pediatric Anesthesia, 2004.


M icrocuff endotracheal tubes provide confidence in a sealed airway l.jpg

MICROCUFF* 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.


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MICROCUFF* 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

Dullenkopf, et al. Acta Anaesthesiologica Scandinavica, 2005.


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Evidence-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-extubationstridor: 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


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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

"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.”

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


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MICROCUFF Pediatric – Top Clinical Articles


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MICROCUFF ET tubes offer cost benefits

  • Study by Schmitz compared MICROCUFF*tubes to Sheridan uncuffed tubes

“… 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


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