Development and pilot feasibility testing of an evidence-based endotracheal tube maintenance protocol for critically ill patients: A delphi consensus study

This study aimed to develop and preliminarily pilot-test an evidence-based endotracheal tube (ETT) maintenance protocol for adult critically ill patients in intensive care units. Based on the Population, Intervention, Professional, Outcome, Setting, Type of Evidence framework, an initial protocol draft was constructed via systematic literature synthesis. Two rounds of modified Delphi expert consultations were conducted among a multidisciplinary panel of 12 specialists across 8 tertiary hospitals. Subsequently, a 3-month feasibility pilot involving 10 frontline intensive care unit nurses was implemented to evaluate bedside usability and protocol adherence. Expert questionnaire recovery rates were 100% in both rounds, with an expert authority coefficient (Cr) of 0.896. In Round 2, all retained items achieved acceptable convergence (coefficients of variation ≤ 0.18, mean scores 4.42-5.00), while Kendall W was 0.329 (P < .001). The feasibility pilot demonstrated an overall nursing compliance rate of 88.5% and informed 7 targeted modifications to resolve bedside operational barriers. The finalized protocol comprises pre-procedure governance, intra-procedure interventions (ETT securement, cuff pressure maintenance at 25-30 cm H2O, subglottic drainage, indication-driven suctioning, oral care), and post-procedure emergency response and quality auditing. This study established a standardized, granular, and clinically operable ETT maintenance protocol with robust expert consensus and high bedside usability. It provides a practical framework for critical care nursing, laying the foundation for future multicenter clinical efficacy trials.