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

INTRODUCTION: Prevention of pressure ulcers is a priority in health care. Artificial airways cause pressure ulcers, repositioning the endotracheal tube (ETT) decreases the chances of developing pressure ulcers. METHODS: An adult intubation head (Laerdal) was orally intubated with an 8.0 mm ID ETT (Hi-Lo, Covidien). Of the 15 devices/techniques included, 6 were excluded due to their design that prevented lateral tube movement. The excluded devices were: AMBU (Velcro), AMBU (silicone strap), Thomas, Precision Medical, Portex Quickstrap. Three commercially available devices; Marpac 320 without headstrap, Hollister Anchor Fast, Dale Stabilock, and 6 non-commercial techniques; Lillihei, a modified Lillihei, HyTape, and cotton twill tape using 3 different knots (cow, rolling, and clove hitches) were evaluated for speed in moving the ETT from one corner of the mouth to other. For the commercial devices, the manufacturer’s instructions were read and adhered to, for the non commercial methods simulated clinical practice was used. This action was repeated 10 times for each method. RESULTS: Means ± standard deviations of the times for all techniques/devices were determined and compared using one-way analysis of variance (ANOVA). Significant differences existed across devices/techniques (p < 0.001, see table). Two commercial devices were the fastest (Marpac and Hollister). Both devices used a similar design with one device having a position lock feature, the other did not. With the knotted twill procedure, the cow hitch was the fastest. No statistical difference existed between Marpac, Hollister, Cow Hitch, and Clove Hitch or between Hy Tape and the modified Lillihei method. CONCLUSION: Repositioning is permitted using a myriad of slides, clips, or quick releases. The most common feature in the devices that did not allow for motion was a bite block that centered the airway within the mouth. All of the taping methods (Hy Tape, Lillihei, and modified Lillihei) required a significant degree of disassembly. The longer times coincide with an increase in complexity for the securing method. Sponsored Research - Hollister