The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

A FIXATION DEVICE FOR ORAL ENDOTRACHEAL TUBES REDUCES SPONTANEOUS EXTUBATIONS IN NEONATES

Teresa Volsko RRT, St. Elizabeth Health Center Youngstown, OH, and Robert L. Chatburn RRT, Rainbow Babies & Childrens Hospital, Cleveland, OH.

Accidental endotracheal extubations with infants requiring mechanical ventilation have been associated with acute hypoxia, laryngo trauma, cardiopulmonary compromise and subglottic stenosis. Securing the uncuffed endotracheal tube is imperative in order to prevent complications associated with unplanned extubations. In this study we evaluated the effect of two endotracheal tube taping methods on the incidence of spontaneous extubations.

METHOD: Two hundred forty-four infants admitted to our level two NICU were studied. Infants qualified for the study if they required intubation and mechanical ventilation. Exclusion criteria included infants with suspected or confirmed neurological impairments that prevented purposeful movement; transfers to Level 3 care facilities', and/or those requiring mechanical ventilation for less than 72 hours. Infants requiring restraining devices and/or the use of sedation were excluded from the study. Infants enrolled in the study had their oral endotracheal tube affixed by one of two Methods: (1) adhesive tape was used to fasten the endotracheal tube to the infant's upper lip or (2) the endotracheal tube was held in place by an oral fixation device (aka Logan Bow or nuchal arch; Ped. Nursing 1992; 18:267-70) The device used to secure the endotracheal tube in place was chosen on the basis of device availability. The outcome variable was the rate of spontaneous extubations per 100 ventilator days. A spontaneous extubation was defined as any unplanned dislodgement of the endotracheal tube without regard to precipitant of the event (ie; extubation during retaping, while repositioning infant, during a procedure, etc.) The data were compared with Fisher's Exact Test. Results: The data are shown below:

Logan Bow Adhesive Tape p Value

Demographics

Number of patients(total) 89 155 -

Number by weight (kg)

0 - 1 12 55 -

1 - 1.5 19 31 -

1.5 - 2.0 19 15 -

2.0 - 2.5 19 21 -

2.5 - 4.4 20 33 -

Outcomes

Total extubations(%) 19 60 < 0.0001

Extubations/100 vent days 2.1 3.0 < 0.001

Extubations (%) by weight (kg)

0 - 1 17.9 82.1 < 0.0001

1 - 1.5 10.5 80.6 < 0.0001

1.5 - 2.0 31.6 26.7 0.53

2.0 - 2.5 10.5 14.3 0.55

2.5 - 4.4 35.0 42.4 0.40

CONCLUSION: The use of a logan bow to secure an uncuffed endotracheal tube in place may reduce the unplanned extubation rate on mechanically ventilated infants weighing less than 1.5kg.

Reference: OF-96-009

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