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

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).

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.

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.

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.