Preventing unplanned extubations: A test bench simulation comparing endotracheal tube securing techniques in acute care settings.

BACKGROUND

Effective securing of the endotracheal tube (ETT) after inserting is essential to prevent unplanned extubation (UE). This study compared six ETT securing techniques and a no-device control in resisting to simulated UE, assessing performance across different traction speeds (slow and fast) and planes (frontal and sagittal).

METHOD: A mechanically ventilated mannequin was used. Extubation, defined as a sudden loss of airway pressure, was induced using a tensile testing machine. The required force to cause extubation (forceextubation) was recorded. For each combination of securing technique, traction speed and traction plane, five measurements of forceextubation were collected. Techniques included three cord-based, two elastic adhesive tape-based, one commercial device (AnchorFast™, Hollister), and a control with no securing method.

RESULTS

In the sagittal plane, AnchorFast™ required significantly higher forceextubation (median 75 N [IQR: 52-86]) compared to adhesive tape methods (short: 28 N [19-34], p < 0.001; long: 34 N [24-45], p = 0.026). Cord-based techniques performed similarly to the AnchorFast™. The control setup (i.e., without any securing device) and the elastic adhesive tape showed comparable forceextubation levels which were also significantly lower than that of a single cord with a knot. In the frontal plane, forceextubation was higher than in the sagittal plane (115 N [89;148] and 44 N [26;57], respectively, p < 0.001), and no significant differences were observed between techniques.

CONCLUSION

ETT securing techniques using elastic adhesive tape were less effective at preventing simulated UE than either the AnchorFast™ device or a single cord with a knot.