Upper airway obstruction and sepsis following endotracheal intubation in paediatric cardiac surgical patients in South Africa

Abstract

Background: Endotracheal intubation and mechanical ventilation are associated with potential complications in children. The role of cuffed versus uncuffed endotracheal tubes (ETTs) remains controversial. We aimed to compare the incidence of obstructive airway complications and the development of sepsis between cuffed and uncuffed ETTs, as well as other risk factors associated with these complications.
Methods: This is an observational and quantitative study that retrospectively reviewed charts of patients younger than 12 years undergoing cardiac surgery and requiring cardiopulmonary bypass (CPB) of any duration and postoperative ventilation for at least four hours between January 2017 and July 2018 at a central hospital in KwaZulu-Natal. Data collected included demographics, airway assessment, previous intubations, type and size of ETT, difficulty with intubation, duration of surgery and CPB, duration of intubation and ventilation, ETT change, presence of upper airway obstruction postextubation, and the presence of sepsis. The severity of airway complications was determined according to the interventions necessary. The chi-square test was used to analyse risk factors associated with interventions. A multivariate logistic model was then used to identify independent factors.
Results: Of the 155 patients included, 68.4% were intubated with cuffed ETTs, and 48% had some form of sepsis during the postoperative period. Stridor was found in 48.4%, with the majority (93%) requiring nebulisation. Adjusted odds ratios (OR) of variables affecting airway complications showed that the only significant factor was ETTs that were too large for the airway (OR 3.42; CI 1.55–7.56; p = 0.002). The only factors that significantly increased sepsis were duration of intubation > 3 days (OR 15.46; p < 0.001) and duration of ventilation > 3 days (OR 17.44; p < 0.001).
Conclusion: The use of cuffed ETTs neither increased airway obstruction complications, nor influenced the outcome of sepsis. Cuffed ETTs that are sized correctly are safe to use within the paediatric population presenting for cardiac surgery, including its extended use during the postoperative period.