Intubation Clinical Trial
Official title:
Endoscopic Evaluation of the Paediatric Airway After Prior Prolonged (>24 h) Tracheal Intubation
The purpose of this study is to determine whether possible damages of the trachea caused by a prior prolonged intubation (> 24h) can be observed by rigid endoscopy of the trachea and if cuffed tracheal tubes cause less damages than cuffed tubes.
The aim of the study is to systematically evaluate airway injury by rigid endoscopy in
children (1 month to 16 years of age) with previous prolonged (> 24h) tracheal intubation
with a special focus on whether their trachea was intubated with a cuffed or an uncuffed
tracheal tube.
After induction of anaesthesia and obtaining venous access, neuromuscular blocking agents are
administered and facemask pre-oxygenation occurs for 2 minutes. Direct laryngoscopy is then
performed in the preoxygenated, paralysed and conventionally monitored patient to obtain a
direct vision. Then a rigid endoscope with endoscopy camera is carefully guided through the
larynx down to the carina and drawn back under monitor vision with electronic recording.
An International Study Board Committee (assessor board) will assess the endoscopic records in
a blinded manner using a systematic grading system.
Beside tracheal tube type, factors such as intubator, sedation management, age, length of
intubation, nasal or oral intubation and time point of endoscopy will affect presence,
absence or incidence of potential airway injuries caused by prolonged tracheal intubation.
Thus it is difficult to perform a power calculation to figure out number of patients to
demonstrate or exclude a statistically significant difference between tube types. Using the
incidence of subglottic stenosis, as the worst case scenario outcome after longterm
intubation, an incidence of less than 2 % seems to be reasonable in uncuffed tracheal
tubes.So the primary hypothesis to be tested is equivalence in major complication rates
defined as subglottic stenosis comparing cuffed versus uncuffed tracheal tubes.
Specifically, the primary hypothesis relates to the main outcome criteria of this study,
which is subglottic stenosis after longterm intubation. The null-hypothesis Ho is defined as
no difference in the incidence rates of subglottic stenosis between cuffed and uncuffed
groups. The null-hypothesis (Ho: μ-Diff = 0) will be compared with the alternative hypothesis
(H1: μ-Diff <> 0). The study is designed to detect a clinically unacceptable deterioration of
4% above the baseline airway-injury rate of 2% when using uncuffed tubes with a power of 80%
and a type I error probability of less than 5%. Sample sizes of 376 from the cuffed group and
376 from the uncuffed group achieve 80% power at a 5% significance level using a one-sided
equivalence test of proportions when the proportion in the standard group (uncuffed TT) is
0.02 and the proportion in the experimental group (cuffed TT) being tested for equivalence is
0.02 and the maximum allowable increase between these proportions that still results in
equivalence (the range of equivalence) is 0.04. In total 1000 patients with prior long-term
intubation (> 24 hours) using a cuffed (500) or an uncuffed (500) tracheal tube will be
recruited / included from different study centres.
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