Comparison of Commercial and Non-Commercial Endotracheal Tube Securing Devices

INTRODUCTION: Tracheal intubation is used to establish a secure airway in patients who require mechanical ventilation. Unexpected extubation can have serious complications including airway trauma and death. Various methods and devices have been developed to maintain endotracheal tube (ETT) security. Associated complications include pressure ulcers due to decreased tissue perfusion. Device consideration includes ease of use, rapid application, and low exerted pressure around the airway.

METHODS: Sixteen ETT holders were evaluated under a series of simulated clinical conditions. ETT security was tested by measuring distance displaced after a tug. Nine out of the 16 devices could be evaluated for speed of moving the ETT to the opposite side of the mouth. Sensors located on a mannequin measured applied forces when the head was rotated vertically or horizontally. Data were analyzed using multivariate ANOVA with p < 0.05 as significant.

RESULTS: Median displacement of the ETT by the Tug test was 0 cm, IQR 0.0 – 0.10 cm, p < 0.0001. The mean time to move the ETT from one side of the mouth to the other ranged from 1.25 ± 0.2 s to 34.4 ± 3.4 s, p < 0.0001.

Forces applied to the face with a vertical head lift ranged < 0.2 N to a maximum of 3.52 N, p < 0.0001. Forces applied to the face with a horizontal rotation ranged < 0.2 N to 3.52 N, p < 0.0001. Commercial devices produced greater force than non-commercial.

CONCLUSION: Non-commercial airway holders exert less force onto the patient's face than commercial devices. Airway stability is affected by the type of securing device.Many of the commercial holders allow for a rapid, but secure movement of the artificial airway from one side of the mouth to the other.