Compared to adult anatomy, children have a floppier epiglottis and vocal cords that slant upward. They also have a funnel-shaped larynx, which can be difficult to navigate around, especially due to the narrowing of the cricoid cartilage.1
Those factors make using scaled-down versions of adult endotracheal tubes (ETTs) on children risky because doing so can result in airway damage, oxygen deprivation, and ventilation complications.1,2
The Shiley™ paediatric oral/nasal endotracheal tube (ETT) with TaperGuard™ cuff technology is designed with a number of features that are intended to meet the needs and improve the margin of safety for your smaller patients.3*
Compared to traditional barrel-shaped cuffs, the thinwalled, taper-shaped, low-volume, low-pressure (LVLP) TaperGuard™ cuff:6,7
The Murphy eye presents a challenge for cuff placement on smaller ETTs. Removing the Murphy eye on a cuffed paediatric oral/nasal ETT improves the margin of safety by:⁸
* Internal document, Design Concept Document Falcon II
† Compared to the adult version.
1. J. Holzki, K Brown, R. Carroll, C. Cote. The anatomy of the pediatric airway: Has our knowledge changed in 120 years? A review of historic and recent investigations of the anatomy of the pediatric larynx. Pediatric Anesthesia. 2017 (28): 13-22.
2. Seyeon P. et al, Choice of the correct size of endotracheal tube in pediatric patients Anesth 2022 Oct 31; 17(4): 352–360. Published online 2022 doi: 10.17085/apm.22215 https://www.ncbi.nlm.nih. gov/pmc/articles/PMC9663958/
3. Aker J. An Emerging clinical paradigm: the cuffed pediatric endotracheal tube. AANA Journal. 2008;76(4):293−300.
4. Weiss M, Gerber AC, Dullenkopf A. Appropriate placement of intubation depth marks in a new cuffed paediatric tracheal tube. Br J Anaesth. 2005;94(1):80−87. 8.
5. Bhardwaj N. Pediatric cuffed endotracheal tubes. J of Anaesthesiol Clin Pharmacol. 2013; 29(1):13−18
6. Lichtenthal PR, Wood L, Wong A, Borg U. Pressure applied to tracheal wall by barrel and taper shaped cuffs. Proc Am Soc Anesth Annual Meeting. 2011: A1054.
7. Lichtenthal PR, Maul D, Borg U. Do tracheal tubes prevent microaspiration? Br J Anaesth. 2011;107(5):821−822.
8. Ho AM, Aun CS, Karmakar MK. The margin of safety associated with the use of cuffed pediatric tracheal tubes. Anesthesia. 2002;57(2):173−175.
9. M. Weiss et al, Tracheal tube-tip displacement in children during head-neck movement—a radiological assessment British Journal of Anaesthesia 96 (4): 486–91 (2006)
10. Nutter J, Oppong E, and Pouliot C. Cuffed pediatric endotracheal tubes. Honors Theses. 2019. 2335. https://digitalworks.union.edu/theses/2336