Table 2.
Commonly used paediatric TTs.
| TT | Special features/advantages | Disadvantages/cautions |
|---|---|---|
| Cuffed or uncuffed | ||
Bivona Smiths Medical
|
Reinforced with a ferromagnetic coil; flexible and kink resistant Commonly used because of its comfort and versatility Paediatric (standard length); neonatal (shorter length) Three different flange shapes to suit a variety of neck shapes and ages Latex free and hydrophobic, hindering protein adhesion; limited secretion build-up and bacterial colonisation Monthly tube change needed Reusable (five times) |
Not compatible with MRI |
Bivona FlexTend
|
Beneficial for children requiring ventilation or with neck masses Fixed kink-resistant flange |
Not compatible with MRI |
Bivona Hyperflex 
|
Designed and customised based on the required style and dimensions Useful to bypass distal anomalies or to fit an abnormally short trachea Adjustable flange permitting the alteration of the tube length |
Not compatible with MRI Temporary tube Unsafe external holding clip; can easily be opened by children |
Shiley, Medtronic 
|
Neonatal (shorter length); paediatric (standard length); long paediatric length available for 5.0–6.5 sizes Latex-free polyvinyl chloride: increased rigidity and easier to insert in an emergency MRI compatible |
Weekly tube change Single use Increased rigidity; less comfort |
| Cuffed | ||
Bivona TTS (tight to shaft) 
|
Useful when weaning children from ventilator Cuff can be deflated completely to assume the profile of an uncuffed tube High-pressure low-volume cuff requires filling with the minimal volume of sterile water to achieve effective ventilation |
Not compatible with MRI Not first-line tube for ventilator support Risk of tracheal necrosis if cuff is overfilled Requires regular deflations |
Bivona Fome 
|
Self-inflating tube, high level of protection from aspiration with optimal comfort Auto-expanding foam in cuff fills and conforms to the unique contours of the trachea |
Not compatible with MRI Insertion and removal very different from other tubes; requires a three-way tap (seek advice) |
Bivona Aire 
|
Air-inflated cuff that provides useful protection against aspiration and optimisation of ventilation | Not compatible with MRI Requires 4 hourly pressure checks with manometer |
| Uncuffed | ||
Montgomery T-Tube, Boston Medical Products 
|
Soft silicone tube that is shaped like a ‘T’ Stents the upper airway after laryngotracheal reconstructive surgery Changed under general anaesthesia |
Requires adaptor for resuscitation and artificial ventilation |
Silver Tubes
|
Very thin walls; can be used with inner tubes without compromising airflow Minimal stoma inflammation Monthly tube change Reusable |
Rigid; uncomfortable High initial outlay cost Require adaptors for resuscitation and artificial ventilation Not compatible with MRI May distort CT images |