Effect of Thermal Softening of Endotracheal Tubes on Perioperative Respiratory Adverse Events in Children Undergoing Adenotonsillectomy: A Randomized Controlled Trial.
Mustafa Dikici, Ahmet Kaciroglu, Eralp Cevikkalp et al.
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In 30 seconds
This prospective randomized controlled trial assessed whether warming endotracheal tubes (ETTs) to 37°C reduces perioperative respiratory adverse events (PRAEs) in 254 children aged 3–9 years undergoing elective adenotonsillectomy. From extubation through the second postoperative hour, PRAEs occurred less often with warmed than room-temperature ETTs (14.1% vs. 24.6%; p = 0.039). Laryngospasm and postoperative coughing were also less frequent in the warmed-tube group, while oxygen desaturation, bronchospasm, hemodynamic measures, and ventilatory variables did not differ significantly. The findings support an association between ETT warming and fewer PRAEs in this trial population.
Key findings
- Overall PRAE incidence was 14.1% with warmed ETTs versus 24.6% with room-temperature ETTs (p = 0.039).
- Laryngospasm occurred in 2.3% versus 8.7% (p = 0.029), and postoperative coughing in 11.7% versus 21.4% (p = 0.043), respectively.
- Room-temperature ETT use (adjusted OR: 2.29; 95% CI: 1.16-4.54) and higher Obstructive Sleep Apnea-18 score (adjusted OR: 1.04; 95% CI: 1.01-1.07) independently predicted PRAEs.
Why it matters
PRAEs are an important source of morbidity around pediatric adenotonsillectomy. In this randomized trial, a simple change in ETT preparation was associated with fewer overall events, particularly laryngospasm and coughing. The absence of significant differences in desaturation and bronchospasm means the observed benefit was not uniform across respiratory outcomes, but the results identify a potentially relevant perioperative airway-safety measure for further evaluation.
What to keep in mind
The trial included children aged 3–9 years undergoing elective adenotonsillectomy; generalizability to other populations or procedures is uncertain. The authors state that multicenter studies are needed to confirm the findings and clarify mechanisms.