Anesthesia Experts

Securing an Endotracheal Tube: Commercial Fastener or Tape?

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 Author: Landsperger JS et al. 

Crit Care 2019 May 7

In this randomized ICU study, tube dislodgement and skin breakdown were more common when tape was used.

Clinicians have many options for securing an endotracheal tube (e.g., tape, cotton twill, mechanical devices). Frequently, the option chosen is based on habit or personal preference, due to the lack of patient-centered evidence.

In this open-label trial, 500 patients requiring intubation in a medical intensive care unit were randomized to use of adhesive tape or a commercial fastener (Hollister AnchorFast Guard) to stabilize their endotracheal tube. After excluding patients with brief (<24 hours) intubation duration or missing data, the researchers included 298 patients in the analysis. The average duration of mechanical ventilation was 4 days in both groups. The composite outcome of lip ulcers, facial skin tears, tube dislodgement, and ventilator-associated pneumonia was significantly less common in the tube fastener group (8% vs. 17%). Use of a fastener also reduced the need to reposition the tube more than 1 cm (4% vs. 10%) but did not impact the rate of self-extubation (1% in each group).

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