Evaluation of Endotracheal Tube Fixation Methods

Note: The Original PI was Alan Stokes, LCDR, USN.

Insertion and maintenance of oral endotracheal tubes (ETT) are among the most common procedures in critical care units. Data are lacking regarding the most effective method of securing these tubes. The purpose of this randomized, comparative study was to compare adhesive tape or a tube-fixation device, for differences in (a) tube stability, (b) facial skin integrity, (c) oral mucosal integrity, (d) patient comfort, (e) family distress, (f) nurse satisfaction with tube stability and (g) ability to render care, and (h) cost.

Study sites were the ICUs at the National Naval Medical Center and the National Institutes of Health Clinical Center. Each site was to accrue 52 subjects (total of 104). Eligible subjects were to be randomized into one of the methods and variables measured at fixed intervals for a maximum of 2 weeks. Instruments included (a) the Stages of Pressure Ulcer Scale, (b) the Oral Dysfunction Score Scale, (c) the Ramsey Scale, (d) visual analogue scales to assess patient comfort, (e) nurse satisfaction with the method of securing the tube, and (f) family reaction to seeing the patient after intubation, and (g) standard clinical measures.

Descriptive statistics were to be used to describe the sample. Mixed-factor repeated measures analysis of variance and unpaired one-directional t tests were to be used to measure differences in the dependent variables. Time series analysis would have been used to determine if data could be averaged across the time points.

No usable data were collected during the 3 years of this study. Lessons learned include (a) the PI must develop the project; (b) if the PI is removed, the study should be terminated; (c) research in institutions unfamiliar with the process require additional manning by research personnel; and (d) assuming that the staff nurse will collect reliable, valid data is not accurate.

Final Report is available on NTRL at: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2007107...