Stridor in neonates after using the Microcuff®and uncuffed tracheal tubes: A retrospective review

Madhankumar Sathyamoorthy, Jerrold Lerman, Rajeshri Asariparampil, Alan D. Penman, Satyanarayana Lakshminrusimha

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

BACKGROUND: We conducted a retrospective chart review to determine the frequency of stridor and contributing factors after the use of Microcuff® and uncuffed tracheal tubes (TTs) in neonates. METHODS: All neonates in our neonatal intensive care unit whose airways were intubated between May 2011 and June 2012 were included. Data were collected from the neonatal intensive care unit database and from the electronic anesthesia record. Extracted data included postmenstrual age (PMA) at birth, birth weight, TT size and type, duration of tracheal intubation, and number of reintubations. The use of racemic epinephrine, heliox, and/or dexamethasone postextubation was considered diagnostic of stridor. RESULTS: Of the 324 neonates whose data were reviewed, 27 (8.3%) developed postextubation stridor. Neonates who developed stridor were more premature (PMA at birth, 29.9 ± 5.8 vs 33.0 ± 4.8 weeks, P = 0.001), had a lower birth weight (1.56 ± 1.07 vs 2.02 ± 0.96 kg, P = 0.005), greater duration of intubation (median: 20 vs 3 days, P > 0.0001), and multiple reintubations (median: 2 vs 0, P > 0.0001). The frequency of stridor was 17.2% after using Microcuff TT and 7.5% after using uncuffed TTs (Fisher exact test, 2-sided P = 0.08 [95% confidence interval for difference in proportions: -9.4% to 28.7%]). In a multivariable logistic regression model, after adjusting for PMA, birth weight, duration of intubation, and number of reintubations, the use of a Microcuff TT was associated with increased odds of stridor (adjusted odds ratio = 9.27 [95% confidence interval: 1.88-45.67], P = 0.006). CONCLUSIONS: The use of the Microcuff TT is associated with increased odds of postextubation stridor in neonates compared with the use of uncuffed TT.

Original languageEnglish (US)
Pages (from-to)1321-1324
Number of pages4
JournalAnesthesia and Analgesia
Volume121
Issue number5
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

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Respiratory Sounds
Intubation
Birth Weight
Neonatal Intensive Care Units
Racepinephrine
Logistic Models
Parturition
Confidence Intervals
Dexamethasone
Anesthesia
Odds Ratio
Databases

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Stridor in neonates after using the Microcuff®and uncuffed tracheal tubes : A retrospective review. / Sathyamoorthy, Madhankumar; Lerman, Jerrold; Asariparampil, Rajeshri; Penman, Alan D.; Lakshminrusimha, Satyanarayana.

In: Anesthesia and Analgesia, Vol. 121, No. 5, 01.11.2015, p. 1321-1324.

Research output: Contribution to journalReview article

Sathyamoorthy, Madhankumar ; Lerman, Jerrold ; Asariparampil, Rajeshri ; Penman, Alan D. ; Lakshminrusimha, Satyanarayana. / Stridor in neonates after using the Microcuff®and uncuffed tracheal tubes : A retrospective review. In: Anesthesia and Analgesia. 2015 ; Vol. 121, No. 5. pp. 1321-1324.
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abstract = "BACKGROUND: We conducted a retrospective chart review to determine the frequency of stridor and contributing factors after the use of Microcuff{\circledR} and uncuffed tracheal tubes (TTs) in neonates. METHODS: All neonates in our neonatal intensive care unit whose airways were intubated between May 2011 and June 2012 were included. Data were collected from the neonatal intensive care unit database and from the electronic anesthesia record. Extracted data included postmenstrual age (PMA) at birth, birth weight, TT size and type, duration of tracheal intubation, and number of reintubations. The use of racemic epinephrine, heliox, and/or dexamethasone postextubation was considered diagnostic of stridor. RESULTS: Of the 324 neonates whose data were reviewed, 27 (8.3{\%}) developed postextubation stridor. Neonates who developed stridor were more premature (PMA at birth, 29.9 ± 5.8 vs 33.0 ± 4.8 weeks, P = 0.001), had a lower birth weight (1.56 ± 1.07 vs 2.02 ± 0.96 kg, P = 0.005), greater duration of intubation (median: 20 vs 3 days, P > 0.0001), and multiple reintubations (median: 2 vs 0, P > 0.0001). The frequency of stridor was 17.2{\%} after using Microcuff TT and 7.5{\%} after using uncuffed TTs (Fisher exact test, 2-sided P = 0.08 [95{\%} confidence interval for difference in proportions: -9.4{\%} to 28.7{\%}]). In a multivariable logistic regression model, after adjusting for PMA, birth weight, duration of intubation, and number of reintubations, the use of a Microcuff TT was associated with increased odds of stridor (adjusted odds ratio = 9.27 [95{\%} confidence interval: 1.88-45.67], P = 0.006). CONCLUSIONS: The use of the Microcuff TT is associated with increased odds of postextubation stridor in neonates compared with the use of uncuffed TT.",
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T1 - Stridor in neonates after using the Microcuff®and uncuffed tracheal tubes

T2 - A retrospective review

AU - Sathyamoorthy, Madhankumar

AU - Lerman, Jerrold

AU - Asariparampil, Rajeshri

AU - Penman, Alan D.

AU - Lakshminrusimha, Satyanarayana

PY - 2015/11/1

Y1 - 2015/11/1

N2 - BACKGROUND: We conducted a retrospective chart review to determine the frequency of stridor and contributing factors after the use of Microcuff® and uncuffed tracheal tubes (TTs) in neonates. METHODS: All neonates in our neonatal intensive care unit whose airways were intubated between May 2011 and June 2012 were included. Data were collected from the neonatal intensive care unit database and from the electronic anesthesia record. Extracted data included postmenstrual age (PMA) at birth, birth weight, TT size and type, duration of tracheal intubation, and number of reintubations. The use of racemic epinephrine, heliox, and/or dexamethasone postextubation was considered diagnostic of stridor. RESULTS: Of the 324 neonates whose data were reviewed, 27 (8.3%) developed postextubation stridor. Neonates who developed stridor were more premature (PMA at birth, 29.9 ± 5.8 vs 33.0 ± 4.8 weeks, P = 0.001), had a lower birth weight (1.56 ± 1.07 vs 2.02 ± 0.96 kg, P = 0.005), greater duration of intubation (median: 20 vs 3 days, P > 0.0001), and multiple reintubations (median: 2 vs 0, P > 0.0001). The frequency of stridor was 17.2% after using Microcuff TT and 7.5% after using uncuffed TTs (Fisher exact test, 2-sided P = 0.08 [95% confidence interval for difference in proportions: -9.4% to 28.7%]). In a multivariable logistic regression model, after adjusting for PMA, birth weight, duration of intubation, and number of reintubations, the use of a Microcuff TT was associated with increased odds of stridor (adjusted odds ratio = 9.27 [95% confidence interval: 1.88-45.67], P = 0.006). CONCLUSIONS: The use of the Microcuff TT is associated with increased odds of postextubation stridor in neonates compared with the use of uncuffed TT.

AB - BACKGROUND: We conducted a retrospective chart review to determine the frequency of stridor and contributing factors after the use of Microcuff® and uncuffed tracheal tubes (TTs) in neonates. METHODS: All neonates in our neonatal intensive care unit whose airways were intubated between May 2011 and June 2012 were included. Data were collected from the neonatal intensive care unit database and from the electronic anesthesia record. Extracted data included postmenstrual age (PMA) at birth, birth weight, TT size and type, duration of tracheal intubation, and number of reintubations. The use of racemic epinephrine, heliox, and/or dexamethasone postextubation was considered diagnostic of stridor. RESULTS: Of the 324 neonates whose data were reviewed, 27 (8.3%) developed postextubation stridor. Neonates who developed stridor were more premature (PMA at birth, 29.9 ± 5.8 vs 33.0 ± 4.8 weeks, P = 0.001), had a lower birth weight (1.56 ± 1.07 vs 2.02 ± 0.96 kg, P = 0.005), greater duration of intubation (median: 20 vs 3 days, P > 0.0001), and multiple reintubations (median: 2 vs 0, P > 0.0001). The frequency of stridor was 17.2% after using Microcuff TT and 7.5% after using uncuffed TTs (Fisher exact test, 2-sided P = 0.08 [95% confidence interval for difference in proportions: -9.4% to 28.7%]). In a multivariable logistic regression model, after adjusting for PMA, birth weight, duration of intubation, and number of reintubations, the use of a Microcuff TT was associated with increased odds of stridor (adjusted odds ratio = 9.27 [95% confidence interval: 1.88-45.67], P = 0.006). CONCLUSIONS: The use of the Microcuff TT is associated with increased odds of postextubation stridor in neonates compared with the use of uncuffed TT.

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