Mechanical stability of endotracheal tube fixation: a performance comparison between two tube holders and a conventional method

Accidental extubation remains a significant clinical concern in airway management, particularly in emergency and anesthetic settings. While commercial tube holders have shown improved fixation stability over adhesive tape, cost and availability limit their use in many healthcare systems. This study introduces a newly developed Iranian endotracheal tube (ETT) holder, Persifix, and evaluates its mechanical performance relative to a commercial Locktite model and the conventional adhesive tape method.

A total of 170 controlled tests were conducted using a human airway manikin. Three fixation methods-adhesive tape, Persifix, and Locktite tube holders-were assessed under lateral and frontal force vectors using weights of 750 g and 1000 g. Displacement was measured in both depth and lateral dimensions under dynamic (tug) and static (non-tug) conditions. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests, with Bonferroni's post hoc comparisons (α = 0.05).

The adhesive tape method demonstrated significantly greater displacement in depth across most test conditions (e.g., left side, 1000 g, no tug: 2.54 ± 3.63 mm vs. Persifix: 1.76 ± 1.78 mm, p = 0.032; Locktite: 0.53 ± 0.44 mm, p < 0.001). In frontal force tests with 1000 g and tug, the Persifix showed reduced displacement (0.41 ± 0.16 mm) compared to both adhesive tape (2.62 ± 4.25 mm, p = 0.001) and Locktite (0.52 ± 1.33 mm, p = 0.032). Lateral displacement in width was also significantly lower with both tube holders (e.g., 750 g with tug: Persifix 3.34 ± 5.20 mm vs. adhesive tape 3.16 ± 15.00 mm, p = 0.005). No statistically significant differences were observed between the Persifix and Locktite tube holders in most conditions (p > 0.05), indicating comparable fixation stability.

The Iranian tube holder, Persifix, demonstrated statistically significant reductions in ETT displacement compared to adhesive tape across multiple force vectors and weight conditions. Its mechanical performance was comparable to the commercial Locktite model, suggesting its potential utility as a cost-effective and clinically reliable alternative for airway stabilization in resource-limited settings.