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

Abstract

<h4>Background</h4>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).<h4>Method</h4>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 (force_extubation) was recorded. For each combination of securing technique, traction speed and traction plane, five measurements of force_extubation were collected. Techniques included three cord-based, two elastic adhesive tape-based, one commercial device (AnchorFast™, Hollister), and a control with no securing method.<h4>Results</h4>In the sagittal plane, AnchorFast™ required significantly higher force_extubation (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 force_extubation levels which were also significantly lower than that of a single cord with a knot. In the frontal plane, force_extubation 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.<h4>Conclusion</h4>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.