Endotracheal tube extubation force: adhesive tape versus endotracheal tube holder

Adhesive tape is commonly used to secure the endotracheal tube (ETT) in anesthesia and intensive-care settings.

To determine the force required to extubate when the ETT is secured with adhesive tape or commercially available ETT holders.

We orally intubated a simulation manikin with a standard 8.0-mm inner-diameter ETT, inflated the cuff to 20 cm H(2)O, and measured the force required to extubate with the ETT secured in several ways. We tested 3 brands of tape (Durapore, Multipore Dry, and Wardel) with 6 methods, and 2 commercially available ETT holders (LockTite and Thomas) with one method. We also tested a bite block (Universal Bite Block) with 2 methods. We used a releasable cable tie with the bite block and/or ETT holder. We connected the ETT to a digital force gauge and pulled perpendicular to the oral cavity, until the entire cuff was removed from the trachea. In each trial we considered the largest force recorded the extubation force.

One of the conventional tape methods (with wider tape and longer tape strips) required the largest force to extubate.

With tape strips of sufficient length and width, a conventional tape method was superior to the 2 tested commercial ETT holders in holding the ETT in place in the manikin.