The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Thomas Malinowski1, Rebecca N. McLaughlin2, Mary Jane Bowles3; 1Respiratory Care, Mary Washington Hospital, Fredericksburg, VA; 2Critical Care Nursing, Mary Washington Hospital, Fredericksburg, VA; 3Nursing Center of Excellence, Mary Washington Hospital, Fredericksburg, VA

Background Endotracheal tube(ET) stabilization is a priority practice in intensive care units. It is equally important to prevent iatrogenic sores to the mouth and lips when securing the ET. There is no research which would substantiate a timeframe to reposition a tube. We compared three interval frequencies (12, 24, 36 hrs.) of ET repositioning as a method to determine injury avoidance, and observed differences in skin breakdown in intubated adult patients using a single, commonly available commercial tube holder. Methods After receiving IRB approval, 449 adult mechanically ventilated and intubated patients admitted to the SICU/MICU were prospectively enrolled in the study between July 2009 and April 2010. All ET were secured using the ETAD Hollister Oral Endotracheal Tube Attachment Device upon arrival, or upon intubation in the ICU. The ET tube was repositioned during the initial ventilator check and corresponded with the required study interval. The respiratory therapist and nurse worked collaboratively to evaluate skin integrity and recorded observations on a data collection sheet. The baseline saw 128 consecutive patients on a 12 hour tube repositioning regimen (July – September 2009). The first phase (3 months, October-December 2009) placed 145 consecutive patients on a 12 hour tube repositioning regimen. The second phase (January – March 2010) saw 132 consecutive patients placed on a 24 hour repositioning regimen. The third phase was originally slated for April – June 2010, with 120+ projected patients, but only 44 consecutive patients placed on a 36 hour regimen. The primary outcome was the incidence of oral ulcerations or skin breakdown at the site of the tube. Results The baseline incidence of ulceration (events/patient) was 3.9%. A 5% incidence was considered a clinically significant threshold. Phase one shows a 2.8% incidence of ulcerations; Phase two a 4.5% incidence, Phase three a 15.9% incidence. The study was terminated early in the third phase because the incidence of events exceeded our threshold. Statistical analysis via Pearson’s Correlation Coefficient showed a strong correlation between ulcers and prolonged repositioning times (r =.941). Conclusions Our results indicate that ET should be re-positioned at least every 24 hours to avoid a 5% incidence of skin ulceration. Further studies should evaluate if more frequent repositioning results in a lower incidence of ulceration. Sponsored Research - None