tracheostomy tube pediatric shiley tubes tracheal trach cuffed holders endotracheal flange sizes holder upto Best practice in stabilization of oral endotracheal tubes: a systematic review. Australian Crit Care. Dupont WD, Plummer WD. Sign up to hear about new product launches, deals, events, CEUs and other educational resources. Armonk, NY). Part of All authors approved the final version of the manuscript submitted. Several techniques are utilized in current clinical practice to secure the endotracheal tube [2], in order to maintain a patent airway and prevent complications. 2012;35(3):24754. The use of the endotracheal tube fastener to secure the endotracheal tubes reduces the rate of a composite outcome that included lip ulcers, facial skin tears, or endotracheal tube dislodgement compared to adhesive tape. Due to the differences in age in baseline demographics, a post hoc ordinal regression was undertaken with age and randomization group as independent variables and rate of composite endpoint per 1000 ventilator days as the dependent variable. tracheostomy airlife Data collection utilized the Research Electronic Data Capture (REDCap) tool developed and maintained with Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). The primary analysis was conducted on an intention-to-treat basis (patients with protocol violations were analyzed per the assigned treatment arm). Respir Care. 2007;50(6):68691. Patients were excluded if they (1) were intubated greater than 12h prior to admission to the MICU, (2) had oral mucosa or facial skin breakdown prior to enrollment, (3) required nasotracheal intubation, (4) had a documented allergy to tape, (5) were pregnant, or (6) were prisoners. While many respiratory therapists may have a personal preference towards one particular securement technique, usually due to ease of use, superiority of one technique over another with regard to outcomes has not previously been demonstrated. During this project, Dr. Rice was supported by the VICTR Learning Healthcare System Platform under CTSA award no. In addition, lip ulcers and skin tears are considered never events by payer sources, meaning that treatment of these complications is not reimbursed as part of patient care costs. tracheostomy ties posey secure tube inch supplies respiratory foam fits neck adult pinit atc hbbd```b``` b+` D2i`&:`v4!$k/iR`L, 3` Od https://doi.org/10.1186/s13054-019-2440-7, DOI: https://doi.org/10.1186/s13054-019-2440-7. In conclusion, in this trial involving critically ill adults, securement of an endotracheal tube with a tube fastener resulted in a lower incidence of and fewer patients experiencing lip ulcers, endotracheal tube dislodgements, or facial skin tears compared to securement with adhesive tape. The study was approved by the Vanderbilt University Medical Center Institutional Review Board with a waiver of consent. statement and Data were collected prospectively at the time of intubation and from the medical record in order to determine the effect of the assigned intervention on short- and long-term outcomes. Tracheal intubation in the critically ill: a multi-centre national study of practice and complications. For both groups, oral hygiene was performed every 12h and oral moistening every 2h based on ICU policy. tracheostomy airlife The overall rates of the development of the composite endpoint were 22.0 (95% CI 16.3 to 27.7) versus 52.6 (95% CI 47.4 to 57.8) per 1000 patient ventilator days (p=0.020) in the tube fastener and adhesive tape groups, respectively (Table2; Fig. The study protocol has been reviewed by the Institutional Review Board (IRB) Health Science Committee 1 at Vanderbilt University, and the need for informed consent from the patients was waived with a participant notification sheet (#170596). Univariate analysis demonstrated an OR of 2.33 (95% CI 1.134.83; p=0.022) for the development of the composite endpoint when adhesive tape compared to tube fastener was used for endotracheal tube securement. Secondary outcome measures included each of the individual components of the primary composite outcome (i.e., presence of lip ulcer, endotracheal tube dislodgement, ventilator-associated pneumonia, or facial skin tears), duration of mechanical ventilation, and ICU and hospital mortality. The authors declare that they have no competing interests. Mechanical ventilation duration and ICU and hospital mortality did not differ. This manuscripts contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. One hundred fifty-three were randomized to the tube fastener and 145 were randomized to adhesive tape (Fig. These results suggest that the use of an endotracheal tube fastener rather than adhesive tape will result in fewer lip ulcers, endotracheal tube dislodgements, and facial skin tears. 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 (p=0.014) for an overall incidence of 22.0 versus 52.6 per 1000 ventilator days, respectively (p=0.020). The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. The trial has limitations. There were no significant differences in baseline characteristics between the patients assigned to receive tube fastener and those assigned to receive adhesive tape (Table1). Multivariate analysis including age as a covariate demonstrated no independent association between age and development of the composite endpoint (OR 1.00; 95% CI 0.981.02; p=0.84) and similar OR for the development of the composite endpoint in adhesive tape versus tube fastener (OR 2.32; 95% CI 1.114.76; p=0.026). tracheostomy ties posey secure tube inch supplies respiratory foam fits neck adult pinit atc suction taping endotracheal nicu neobar inservice The use of an endotracheal tube fastener might reduce complications among critically ill adults undergoing endotracheal intubation. We estimated the expected incidences of tube dislodgement and lip ulcer development to be 20 and 1.1 per 1000 ventilator days, respectively, based on the data from the previous 12months. Shimizu T, Mizutani T, Yamashita S, Hagiya K, Tanaka M. Endotracheal tube extubation force: adhesive tape versus endotracheal tube holder. cpap o2 airway Ann Emerg Med. 2015;64:18396. The following in-hospital outcomes were recorded via electronic medical record review: days on mechanical ventilation, and vital status at the time of ICU and hospital discharge. California Privacy Statement, Provided by the Springer Nature SharedIt content-sharing initiative. Hospital mortality was also similar between the 2 groups with 57 patients (37.3%) in the tube fastener group and 54 (37.2%) in the adhesive tape group dying prior to hospital discharge (p=0.99). In this pragmatic, single-center, randomized trial, critically ill adults admitted to the medical intensive care unit (MICU) and expected to require invasive mechanical ventilation for greater than 24h were randomized to adhesive tape or endotracheal tube fastener at the time of intubation. Secondary endpoints included duration of mechanical ventilation and ICU and in-hospital mortality. examined the force required to extubate endotracheal tubes from cadavers with either tape or endotracheal tube fastener [5]. Zaratkiewicz S, Teegardin C. Retrospective review of the reduction of oral pressure ulcers in mechanically ventilated patients: a change in practice. However, given this study was undertaken in cadavers, it is unclear if these results translate to adult patients in the ICU. For obvious reasons, the trial was open-label and not blinded, with investigators and clinical personnel aware of the allocation group. Inclusion and enrollment of patients. The primary endpoint was the continuous variable of incidences of lip ulcers, tube dislodgement, or ventilator-associated pneumonia per 1000 ventilator days. PubMedGoogle Scholar. The effect of adhesive tape versus endotracheal tube fastener in critically ill adults: the endotracheal tube securement (ETTS) randomized controlled trial, https://doi.org/10.1186/s13054-019-2440-7, for the Pragmatic Critical Care Research Group, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 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 (p=0.053) in the fastener and tape groups, respectively. 1227 0 obj <>/Filter/FlateDecode/ID[<74E98897AD6A034AB5928C3F9F6D8F64>]/Index[1206 44]/Info 1205 0 R/Length 103/Prev 500396/Root 1207 0 R/Size 1250/Type/XRef/W[1 3 1]>>stream Total ventilation time for all 153 patients in the tube fastener group was 590days (mean duration 3.93.0days) compared to 570days for the 145 patients in the tape group (mean duration 3.93.4days) (p=0.75). Additionally, endotracheal intubation and mechanical ventilation are associated with ventilator-associated pneumonia. Department of Medicine, Vanderbilt University, T-1218 Medical Center North, Nashville, TN, 37232-2650, USA, Janna S. Landsperger,Jesse M. Byram&Todd W. Rice, Department of Respiratory Therapy, Vanderbilt University, T-1218 Medical Center North Nashville, Nashville, TN, 37232-2650, USA, T-1218 Medical Center North, Vanderbilt University, Nashville, TN, 37232-2650, USA, You can also search for this author in %PDF-1.5 % However, endpoints were objective and strictly defined, thus limiting the subjectivity of the evaluation. While there was no difference between the groups in clinical outcomes, including duration of mechanical ventilation and ICU or hospital mortality, reducing the rate of lip ulcers, endotracheal tube dislodgements, and facial skin tears will improve patient safety and experience in the ICU and also likely decrease the cost of care. 2). The primary endpoint, a composite of presence of lip ulcer, endotracheal tube dislodgement, ventilator-associated pneumonia, or facial skin tears from the time of randomization to the earlier of death or 48h after extubation, 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 (p=0.014). volume23, Articlenumber:161 (2019) If patients were intubated within 12h of admission to the MICU, they were eligible for inclusion in the study. Lip ulcer occurred in 4 (2.6%) versus 11 (7.3%) (p=0.05) patients for rates of 6.8 (95% CI 5.6 to 8.0) versus 19.3 (95% CI 17.1 to 21.6) per 1000 patient ventilator days (p=0.052) while facial skin tears occurred in 2 (1.4%) versus 3 (2.1%) patients for rates of 3.4 (95% CI 2.0 to 4.8) versus 5.3 (95% CI 4.7 to 5.9) per 1000 patient ventilator days (p=0.622) in the fastener and tape groups (p=0.61), respectively. Of 500 patients randomized over a 12-month period, 162 had a duration of mechanical ventilation less than 24h and 40 had missing outcome data, leaving 153 evaluable patients randomized to tube fastener and 145 evaluable patients randomized to adhesive tape. holder thomas et tube adult airway Cookies policy. 2012;108:7929. et al. 0 endstream endobj 1207 0 obj <>/Metadata 65 0 R/PageLayout/OneColumn/Pages 1202 0 R/StructTreeRoot 104 0 R/Type/Catalog>> endobj 1208 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 1209 0 obj <>stream Google Scholar. Article Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Patients admitted to the MICU from May 17, 2017, to April 14, 2018, who were deemed by their clinical team to require endotracheal intubation and fulfill the inclusion criteria without meeting the exclusion criteria were enrolled and randomly assigned to adhesive tape versus endotracheal tube fastener. You are unable to select more than your available quota at this time. Conduct at a single academic center limits generalizability. CONSORT diagram showing the enrollment of patients into the endotracheal tube securement (ETTS) randomized controlled trial. Overall, using the tube fastener resulted in 19.3 fewer complications per 1000 ventilator days than using adhesive tape. Depth of the tube as measured at the lip line and position in the mouth (i.e., 22cm at the lip, midline) at time of securement was also recorded. The effect of adhesive tape versus endotracheal tube fastener in critically ill adults: the endotracheal tube securement (ETTS) randomized controlled trial. suction taping endotracheal nicu neobar inservice Controlled Clin Trials. Baseline characteristics were similar between the groups. To evaluate the safety and efficacy of endotracheal tube securement techniques, we performed 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 24h. The endotracheal tube securement (ETTS) study was a pragmatic, single-center, open-label, randomized trial comparing the effect of adhesive tape versus endotracheal tube fastener (Hollister AnchorFast Guard) among critically ill adults requiring intubation and mechanical ventilation for at least 24h (ClinicalTrials.gov identifier: NCT03760510). UL1 TR002243 from the National Center for Advancing Translational Sciences. Google Scholar. Patients were randomized to endotracheal tube holder or tape in a 1:1 ratio using random permuted computer-generated blocks of 2, 4, and 6. Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity. ICU mortality was similar, with 52 patients (34.0%) in the tube fastener group and 51 patients (35.2%) in the adhesive tape group dying before ICU discharge (p=0.83). In both groups, the tube was repositioned as needed according to ICU policy or protocols or at the discretion of the provider, bedside nurse, or respiratory therapist, per usual practice. cpap o2 airway Heart Lung. The authors would like to thank the medical staff and respiratory therapists in the Medical Intensive Care Unit at Vanderbilt University Medical Center for their assistance with the trial and the patients enrolled in the trial for their contribution to the study. JSL and TWR contributed to the study concept and design, data analysis and interpretation, and statistical methods and statistical data analysis. In the current trial, the use of a tube fastener resulted in 7.2% fewer patients developing complications compared to adhesive tape. All data were collected non-invasively and were already a part of clinical data obtained in usual ICU care at the bedside or in the medical record. Lip ulcers and facial skin tears are infrequent complications of endotracheal tube securement [2,3,4], but each is associated with increased financial burden and potentially increased length of stay [2]. Once it had been determined by the treating team that a patient was eligible for the study (i.e., intubated less than 12h), the operator opened the envelope and followed the assignment of either adhesive tape or endotracheal tube fastener. Finally, while the overall follow-up was excellent, the pragmatic nature resulted in 40 randomized patients being excluded due to missing primary outcome data. There were no occurrences of ventilator-associated pneumonia in either group. Privacy Of 500 patients randomized, 162 were deemed excluded from the analysis due to the duration of mechanical ventilation less than 24h and 40 had missing outcome data, leaving 298 in the analysis. David R. Janz, MD, Louisiana State University School of Medicine, New Orleans, LA, USA. This study demonstrated that endotracheal tube fasteners reduced the incidence of lip ulcers, skin tears, and tube dislodgement compared to adhesive tape. Using the sum of these overall incidences (i.e., 21.1 per 1000 ventilator days) and a standard deviation of 15 per 1000 ventilator days, PS software [9] calculated a need for 142 evaluable patients in each arm to detect a clinically meaningful change of 5 episodes per 1000 ventilator days with 80% power at a two-sided alpha level of 0.05. Prior studies investigating endotracheal tube securement techniques require that the endotracheal tube be repositioned and re-taped every 24h. However, due to the pragmatic design and intent of this protocol, the endotracheal tube was not repositioned as part of the study protocol in either group. Following intubation for mechanical ventilation, other potential complications may occur, including the development of lip ulcers or skin tears, endotracheal tube dislodgement or advancement, or endotracheal tube plugging or malfunction. To account for the loss of patients not ventilated for 24h and a 5.6% dropout or loss to follow-up rate, we planned to enroll 500 patients to achieve the 284 eligible patients needed for the study. Crit Care Nurs Q. Age, gender, height, weight, race, active medical problems at the time of intubation, active comorbidities complicating intubation, indication for intubation, whether a reintubation, and whether the face was soiled during the intubation were all collected at the time of intubation. Although both tube fasteners and adhesive tube have been used to secure endotracheal tubes in patients in clinical practice for several years, few trials have directly compared the effects of these different securement techniques on patient safety and clinical outcomes [2]. All analyses were conducted using SPSS version 25 (IBM SPSS Statistics for Windows, Version 25.0. Manage cookies/Do not sell my data we use in the preference centre. Article 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 (p=0.03), reflecting incidences of 11.9 and 28.1 per 1000 ventilator days, respectively. Failure to evaluate the performance of the securement technique beyond 2h limits the interpretation of these data into critical care environments where the average duration of mechanical ventilation is measured in days or weeks. Carlson J, Mayrose J, Krause R, Jehle D. Extubation force: tape versus endotracheal tube holders. JSL, JMB, and BDL contributed to the acquisition of the data. Prior to initiation of the study, randomization assignments were placed in sequentially numbered opaque envelopes, which remained sealed until the decision was made to enroll a patient in the study. Egyptian J Chest Dis Tuberc. The optimal securement method of endotracheal tubes is unknown but should prevent dislodgement while minimizing complications. The differences between the two groups were compared using Mann-Whitney U test. endstream endobj startxref cricothyrotomy novatech In 2007, Carlson et al. Continuous outcomes were compared with the Mann-Whitney U test and categorical variables with the chi-square or Fisher exact test as appropriate. 1998;27(6):40917. Critical Care Patients had to be enrolled in the study for a minimum of 24h to be included in the analysis to ensure a reasonable amount of time for complications to occur. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Terms and Conditions, hb``` \eB ce`a```Qrhd8@FMhR|gZT>i5@t8-~z7oWonbt wM9]wM^^sMjGnutKN%>0vt40xt ] dv00H0 *w CG\u8>@,vu cZsLFW2-b))Bc\>C/9k!fRl~iF@sL0 n We conducted an unadjusted analysis examining the treatment effect of endotracheal tube securement method on each of the pre-specified secondary and tertiary outcomes. The endotracheal tube was dislodged 7 times in 6 (3.9%) patients in the tube fastener group and 16 times in 15 patients (10.3%) in the adhesive tape group (p=0.030), with rates of 11.9 (95% CI 6.5 to 17.3) versus 28.1 (95% CI 24.4 to 31.8) per 1000 patient ventilator days (p=0.035). Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Br J Anaesth. 1990;11:11628. The primary endpoint was a composite of any of the following: presence of lip ulcer, endotracheal tube dislodgement (defined as moving at least 2cm), ventilator-associated pneumonia, or facial skin tears anytime between randomization and the earlier of death or 48h after extubation. Endotracheal tube dislodgement sometimes resulting in unplanned extubation, bronchospasm, or tracheal injury is another more common complication of suboptimal tube securement [5,6,7]. As hospital-acquired pressure injuries, treatment of these complications is not reimbursed. This 0.8% loss to follow-up rate was considerably less than anticipated when calculating the sample size needed to power the study and is unlikely to have significantly altered the results. Crit Care 23, 161 (2019). holder thomas et tube adult airway CAS The primary outcome measure was a composite of any of the following: development of lip ulcer, ventilator-associated pneumonia, endotracheal tube dislodgement, or facial skin tears from the time of randomization to the earlier of death or 48h after extubation. Facial skin tears were similar between the groups. Power and sample size calculations: a review and computer program. Cite this article. Proper oral hygiene is essential in decreasing the incidence of ventilator-associated pneumonia [8]. Customer Terms & ConditionsPrivacyTerms of UseCode of ConductSupplier Code of ConductSupplier Terms and ConditionsReturn Policy5000 Tuttle Crossing Blvd., Dublin, OH 43016800.533.0523, 5000 Tuttle Crossing Blvd., Dublin, OH 43016, Endotracheal Tube Twill Tape, Bleached, 1/4in x 36yd. 1206 0 obj <> endobj The most common indication for intubation among both groups was respiratory failure (45.7% versus 53.1%, respectively). Am J Respir Crit Care Med. 2002;165(7):867903. In addition, the composite outcomes of the primary endpoint were independently confirmed by either the quality nurse associate or study personnel. Simpson GD, Ross MJ, McKeown DW, Ray DC. The pragmatic nature of the trial allows for the enrollment of a heterogeneous population of consecutive critically ill patients, and the pragmatic design, without artificially regulating routine endotracheal tube position changes, reflects actual clinical practice, rendering the results more generalizable to the care of critically ill patients in general. %%EOF tracheostomy tube pediatric shiley tubes tracheal trach cuffed holders endotracheal flange sizes holder upto Primary endpoint. Different endotracheal tube securement techniques may have different effects on these complications. Additionally, in 2014, Mohammed and Hassan demonstrated that securement with twill decreased endotracheal tube slippage in the first 120min post intubation compared to tape and tube fastener [2]. In addition, as per usual practice in our ICU, facial skin tears and lip ulcers were independently assessed and confirmed by the nursing quality improvement associate, who was not part of either the patient care or the study team. Anne G, Hughes D, Cook R, Henson R, et al. Endotracheal tube dislodgements were retrospectively confirmed by a study personnel via manual chart review. Correspondence to ClinicalTrials.gov NCT03760510. Ventilator-associated pneumonia. Mohammad H, Hassan M. Endotracheal tube securements: effectiveness of three techniques among orally intubated patients. Prior studies investigating different endotracheal securement techniques are not generalizable to patients mechanically ventilated in an ICU. 1). One of the tube dislodgements was a self-extubation in 2 patients in each group. Barnason S, Graham J, Wild MC, Jensen LB, Rasmussen D, Schulz P, Woods S, Carder B. All hypothesis tests were two-sided, with an of 0.05 unless otherwise specified. Landsperger, J.S., Byram, J.M., Lloyd, B.D. Retrospectively registered on November 30, 2018.

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