The relationship between head and neck position and endotracheal tube intracuff pressure in the pediatric population

Paediatr Anaesth. 2014 Mar;24(3):316-21. doi: 10.1111/pan.12308. Epub 2013 Nov 18.


Background: Over the past few years, there has been a change in clinical practice with a transition to the use of cuffed instead of uncuffed endotracheal tubes (ETTs) in pediatric patients. These changes have led to concerns regarding unsafe intracuff pressures in pediatric patients, which may result in postoperative morbidity. To avoid these issues, it is generally suggested that the intracuff pressure be maintained at ≤30 cmH2 O. The current study prospectively assesses the changes in intracuff pressure related to alterations in head and neck position in pediatric patients.

Methods: Patients less than 18 years of age, undergoing surgery, requiring endotracheal intubation with a cuffed ETT were eligible for inclusion. No alteration in the technique of anesthetic induction or maintenance was required for the study. Following endotracheal intubation and inflation of the cuff with the head and neck in a neutral position, the intracuff pressure was measured. The intracuff pressure was then subsequently measured with the head turned to the right, head turned to the left, head and neck flexed, and head and neck extended.

Results: A total of 200 patients were included in the study resulting in a total of 1000 intracuff pressure readings. When compared to the neutral position, the intracuff pressure increased in 545 instances (68.1%) with changes in position of the head and neck. An increase in intracuff pressure was noted more frequently and to the greatest degree with head and neck flexion. The pressure decreased in 153 instances (19.1%), most frequently with neck extension.

Conclusion: Significant changes in the intracuff pressure occur with changes in head and neck position. In several cases, this resulted in a significant increase in the intracuff pressure. For prolonged cases with the head and neck turned from the neutral position, the intracuff pressure should be measured following patient positioning to ensure that the intracuff pressure is within the clinically recommended range.

Keywords: cuffed endotracheal tube; intracuff pressure; pediatrics.

MeSH terms

  • Adolescent
  • Aging / physiology
  • Air Pressure
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Head
  • Humans
  • Infant
  • Intubation, Intratracheal / methods*
  • Male
  • Neck
  • Patient Positioning*
  • Prospective Studies