The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts


Teresa A. Volsko, RRT, Robert L. Chatburn, RRT, Theresa Schultz*, RRT, Enrique Grisoni, MD, Michelle Walsk-Sukys, MD University Hospitals of Cleveland, OH and *Childrens Hosptial of Philadelphia, PA

BACKGROUND: Accidental extubations may complicate the patient's course. The relatively short trachea, use of uncuffed endotracheal tubes (ET), bedside care, infant's size and activity level along with method of ET fixation contribute to the incidence of accidental extubations in infants and children (Respir Care 1997;42:228-291). We evaluated a new ET securing method, the Neobar (Neotech Products Inc.). This device is a small, plastic arch with adhesive cheek pads. The ET tube is taped to the arch rather than to the patient's upper lip as in conventional ET fixation. We tested the hypothesis that the new fixation device would reduce the incidence of accidental extubations, be easier to apply, would improve skin integrity, and the ability to perform oral care. Methods: This pilot study enrolled infants from our Level III Neonatal Intensive Care Unit requiring intubation and mechanical ventilation. Infants with limb restraints, sedation or paralytic drugs that inhibited activity, along with those who had neurological impairment that prevented purposeful movement, and/or those whose positive pressure ventilation requirements were less than one day (24± 1 hours) or greater than 30 days were excluded from the study. The infants were randomized to either Neobar or conventional tape. The hydrogel adhesive on the cheek pads of the Neobar was applied to dry skin without additional fixatives. A piece of adhesive tape was used to secure the ET to a vertical bar on the arch. The conventional taping method required the application of tincture of benzoin to the area of the upper lip prior to the application of a piece of Elastoplast. One piece of cloth tape, approximately five inches long was applied to the ET by wrapping it around the tube twice and anchoring it to the opposite side of the face, over the Elastoplast. This procedure was repeated with a second piece of tape, which started at the opposite side of the face. A survey was completed by the bedside respiratory therapist or nurse ranking the following categories; on an ordinal scale (good, fair or poor; higher score = better condition). Skin condition was documented upon extubation using an ordinal scale (normal, red, rash, broken, blistered). Distributions of extubations per 100 ventilator days and survey scores were compared with a Mann-Whitney U test. Significance was set at p < = 0.05. Results: Data below are mean ± standard deviation:

Neobar Tape p Value

Number in study 14 18 -

Extubations/100 vent days 4.8 ± 10.3 15.6 ± 32.0 0.40

Total survey score 15.5 ± 1.3 14.4 ± 1.4 0.05

Conclusions: For this study, there was no significant difference in extubations per 100 ventilator days, but there is evidence that a larger sample size might be more informative. Clinical data from the survey showed that the Neobar was superior to tape, particularly in the categories of skin condition and ease of verifying ET placement..

The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.