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Endotracheal Tube Repositioning Frequency for Preventing Oral Mucosal Pressure Injuries in Intensive Care Units: A
Ecem Ozdemır1, Fatos Korkmaz2, Necla Derelı3
1Faculty of Nursing, Ankara University, Ankara, Türkiye.
Background:
Endotracheal tubes (ETTs) exert sustained pressure and friction on the oral mucosa, placing mechanically ventilated intensive care unit (ICU) patients at increased risk of mucosal membrane pressure injuries (MMPIs).
Aim:
To compare the effect of 4-h and 8-h ETT repositioning intervals on the prevention of oral MMPIs in adult ICU patients receiving invasive mechanical ventilation (MV).
Methods:
This study is designed as an analyst-blinded, parallel-group randomised controlled trial. Adult ICU patients receiving invasive MV via an oral ETT and with Acute Physiology and Chronic Health Evaluation System (APACHE II) scores ≤ 24 will be randomised (1:1) to either 4-h or 8-h ETT repositioning intervals, with stratification by APACHE II score (≤ 20 and 21-24). The primary outcome is the development of oral MMPIs during a 14 day follow-up period or until extubation, tracheostomy, transfer or death, assessed using the Reaper Oral Mucosa Pressure Injury Scale-TR. Secondary outcomes include the timing, severity, and anatomical location of MMPIs.
Results:
The primary hypothesis is that a 4-h ETT repositioning interval will significantly reduce the incidence of oral MMPIs compared to an 8-h interval. It is anticipated that more frequent repositioning will better preserve mucosal integrity and improve patient comfort. These results are expected to provide evidence-based guidance for standardizing nursing-led ETT care protocols in ICU.
Relevance For Clinical Practice:
By examining ETT repositioning intervals in relation to disease severity, this study may support more standardised and patient-centred preventive strategies and contribute to safer, more efficient nursing care in intensive care settings.
Trial Registration:
The Clinical Trial Registration number (Unique Protocol ID) is NCT07390162.
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