Comparative Effectiveness of Oral Endotracheal Tube Securement Methods in Adults: A Systematic Review and Network...

Background/Objectives: Securement of oral endotracheal tubes (ETTs) is a critical component of airway management in mechanically ventilated adults. Inadequate fixation may lead to tube displacement, and device-related pressure injuries. The aim of the study was to evaluate the effectiveness and safety of different oral ETT securement evidence in adults. Methods: A comprehensive search was conducted on seven English and Chinese databases (Cochrane Library, PubMed, CINAHL, Web of Science, EMBASE, Airiti Library and CNKI) to identify clinical trials evaluating the effectiveness and safety of different oral endotracheal tube securement methods. Methodological quality of the trials was assessed using the Cochrane Risk of Bias 2 (RoB 2.0) and the Joanna Briggs Institute (JBI) tools. A frequentist network meta-analysis was performed to estimate odds ratios with 95% CIs. The review protocol was registered with INPLASY (INPLASY202480089). Results: A total of 45 studies published between 1993 and 2022 (17 in English and 28 in Chinese) met the inclusion criteria. Compared with adhesive tape, ETT holders (OR 0.15, 95% CI 0.08-0.27) and twill (OR 0.25, 95% CI 0.11-0.59) significantly reduced tube displacement, with no difference between them. For pressure injury, ETT holders showed a significantly lower risk compared with adhesive tape (OR 0.33, 95% CI 0.15-0.70), while evidence for twill was inconclusive. No major inconsistency was detected for pressure injury, whereas inconsistency could not be assessed for tube displacement because the network contained no closed loops. Conclusions: Both twill and ETT holders were more effective than adhesive tape in reducing oral ETT displacement. ETT holders demonstrated more consistent benefits across outcomes and significantly reduced the risk of device-related pressure injury, suggesting they may be the preferred securement method for mechanically ventilated adults. Further high-quality head-to-head trials are needed to strengthen the current evidence.