Commercial fastener better than tape for securing endotracheal tube

USA: The use of an endotracheal tube fastener for securing an endotracheal tube in critically ill adults undergoing endotracheal intubation is associated with a reduced rate of endotracheal tube dislodgement and skin breakdown compared to the use of adhesive tapes.

These are the results of a recent study published in the BMC Journal Critical Care.

There are many options available to the clinicians for securing endotracheal tubes including adhesive tapes, cotton twill, and mechanical devices. The optimal securement method of endotracheal tubes is unknown but should prevent dislodgement while minimizing complications. Janna S. Landsperger, Department of Medicine, Vanderbilt University, Nashville, USA, and colleagues evaluated the safety and efficacy of different endotracheal tube securement techniques.

For this, the researchers conducted a pragmatic, randomized controlled trial comparing the effect of adhesive tape versus endotracheal tube fastener on complications including lip ulcers, facial skin tears, endotracheal tube dislodgement, and ventilator-associated pneumonia among critically ill adults requiring intubation and mechanical ventilation for at least 24 h.

Of 500 patients randomized over a 12-month period, 162 had a duration of mechanical ventilation less than 24 h and 40 had missing outcome data, leaving 153 evaluable patients randomized to tube fastener and 145 evaluable patients randomized to adhesive tape.

The primary endpoint was a composite of any of the following: the presence of lip ulcer, endotracheal tube dislodgement (defined as moving at least 2 cm), ventilator-associated pneumonia, or facial skin tears anytime between randomization and the earlier of death or 48 h after extubation.

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They found that:

• The primary endpoint occurred 13 times in 12 (7.8%) patients in the tube fastener group and 30 times in 25 (17.2%) patients in the adhesive tape group for an overall incidence of 22.0 versus 52.6 per 1000 ventilator days, respectively.


• Lip ulcers occurred in 4 (2.6%) versus 11 (7.3%) patients, or an incidence rate of 6.5 versus 19.5 per 1000 patient ventilator days in the fastener and tape groups, respectively.


• The endotracheal tube was dislodged 7 times in 6 (3.9%) patients in the tube fastener group and 16 times in 15 (10.3%) patients in the tape group, reflecting incidences of 11.9 and 28.1 per 1000 ventilator days, respectively.


• Facial skin tears were similar between the groups.


• Mechanical ventilation duration and ICU and hospital mortality did not differ.