The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Daniel F. Fisher1, Andrew Marchese2, Joseph Kratohvil1, Robert M. Kacmarek1; 1Department of Respiratory Care Services, Massachusetts General Hospital, Boston, MA; 2Massachusetts Institute of Technology, Cambridge, MA

BACKGROUND: Accidental extubation is a serious complication with endotracheal tubes. Numerous commercial and non-commercial devices/methods are available for securing an endotracheal tube (ETT). METHODS: An adult intubation mannequin (Laerdal) was orally intubated with an 8.0 mm internal diameter endotracheal tube (ETT; Hi-Lo, Covidien). The ETT was secured using 1 of 10 commercially available devices, or, 1 of 6 non-commercial techniques; total 16 different approaches. After securing, the cuff was inflated to 25 cm H2O. The ETT was connected to a nylon line. The opposite end of the line was threaded through a pulley and attached to a 578 g weight. The weight was dropped from a height of 3 feet stopping abruptly at 32 inches to produce a jolt of approximately 5.7 N. on the ETT (repeated 5 times). The distance the ETT moved was recorded. Following the fifth drop and measurement, the cuff was deflated, the ETT repositioned, and the securing method refastened. This process was continued for 5 cycles. Four separate devices were used in each evaluation resulting in 100 drop measurements RESULTS: There were 1583/1600 measurements due to 17 extubations. Data was analyzed using the Kruskal-Wallis test; there is a significant difference between devices (p < 0.001). To account for the initial stretch of the neck securing material the first drop from each cycle was removed and the data reanalyzed. There were 1263/1280 measurements. Movement remained significant (p < 0.001) Mean movement for commercial (0.1 ± 0.35 cm) and non-commercial (0.1 ± 0.21 cm) techniques/devices significantly differed (p < 0.001). The tube holder that had the least movement was Anchor Fast (0.009 ± 0.03 cm) and the tube holder with the greatest movement was Precision Medical (0.656 ± 0.87 cm; p < 0.001) Table 1. CONCLUSION: There is significant variation in the ability of the various commercial techniques/devices to keep the ETT stable during a rapid jolt. One of the contributing factors to this variation is the material used to secure the ETT. Sponsored Research - Hollister