The Science Journal of the American Association for Respiratory Care
BACKGROUND: Reapplication of any endotracheal tube (ET) fixation device, to prevent accidental extubation, is time-consuming. A previous study showed that the Neobar was superior to a conventional taping method in a number of ways. The Neobar is a small plastic arch with adhesive cheek pads designed to secure a pediatric patient's ET. The study showed that the Neobar was better regarding ease of application, ability to perform mouth care, reduction of skin irritations, and verification of ET placement. There was also a reduction in the incidence of accidental extubations (Respir Care 1998; 43(10):840.) However, device reapplication was not studied. We hypothesize that the use of the Neobar, compared to conventional tape, would reduce the time-consumed with fixation device reapplication in order to keep the ET secure child's face for the duration of mechanical ventilation.
Methods: This pilot study enrolled children from our Pediatric Intensive Care Unit requiring intubation and mechanical ventilation for greater than 24 hours. The hydrocolloid 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 benzion to the area of the upper lip prior to the application of a piece an extra-thin strip of Duoderm to the cheeks on either side of the nares. The top portion of a pre-cut ?y? shaped piece of one-inch cloth tape was placed over the upper lip with the end affixed to the Duoderm. The bottom end was affixed to the ETT by wrapping it around the tube in a spiral fashion. This procedure was repeated with a second and third piece of tape. Total time consumed with reapplication was defined as the product of standardized device application time and the number of reapplications per ventilator day (Neobar = 5 minutes; tape = 15 minutes). Patient age, weight, gender, ET size and securing device, restraint use, number of reapplications and accidental extubations were recorded. Distributions of labor time, and demographics between groups were compared by paired t-test.
Results: The groups were similar in terms of demographics, ET size, use of physical restraints and/or sedation, p > 0.50. One accidental extubation occurred in each group. Not all patients required reapplication of the endotracheal tube fixation device. Outcome data below are mean ± standard deviation:
|Number in Study||6||11||-|
|Reapplications/ventilator day||0.38 ± 0.29||0.64 ± 0.81||0.35|
|Total time (minutes/ventilator day)||1.97 ± 2.0||5.73 ± 3.8||0.05|
Conclusions: The number of reapplications was not different between the two devices. However, the labor time spent on reapplication of the conventional tape method was almost three times longer than the Neobar.