Document Detail


Effect of airway-securing method on prehospital endotracheal tube dislodgment.
MedLine Citation:
PMID:  19947864     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We compared the effectiveness of common airway-securing techniques in preventing endotracheal tube (ETT) dislodgment in the prehospital setting.
METHODS: This was a prospective, observational, multicenter study conducted at 42 emergency medical services (EMS) agencies. EMS providers completed structured, closed-response data forms for all endotracheal intubation (ETI) attempts during an 18-month period. We included all successful intubations as well as failed ETIs in which ETT securing was performed. EMS providers indicated methods used to secure the ETT, including the use of adhesive tape to the face (face tape), tape wrapped around the neck (neck tape), woven twill or umbilical tape (twill tape), intravenous or oxygen tubing (tubing), commercial tube holders, and manual stabilization/none. Providers also indicated the concurrent use of a cervical collar and/or cervical immobilization device (CID) with backboard. ETT dislodgment was reported by providers. We evaluated the rates and odds of ETT dislodgment for each tube-securing technique using multivariate logistic regression.
RESULTS: Of 1,732 patients undergoing tube-securing efforts, ETT dislodgment occurred in 51 (2.9%). ETT dislodgment rates were as follows: tube held manually, four of 32 (12.5%); face tape, 13 of 292 (4.5%); neck tape, nine of 205 (4.4%); twill tape, zero of 67 (0%); tubing, one of 30 (3.3%); commercial tube holders, 25 of 1,111 (2.3%); cervical collar, two of 121 (1.7%); and CID, 12 of 377 (3.2 %). On multivariate regression, when compared with securing the tube with face tape, only manually holding the tube in place showed a significant difference in the odds of dislodgment (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.2-15.2). Whereas cardiac arrest and trauma did not increase the odds of ETT dislodgment (OR 1.3, 95% CI 0.7-2.6; and OR 0.3, 95% CI 0.1-1.4, respectively), patient age less than 5 years was associated with ETT dislodgment (OR 6.6, 95% CI 2.2-19.7).
CONCLUSION: In this multicenter observational series, the odds of ETT dislodgment were similar for face tape, neck tape, twill tape, plastic tubing, and commercial tube holders. ETT dislodgment did not occur with woven twill tape. Patients under 5 years of age are at heightened risk for ETT dislodgment.
Authors:
Douglas F Kupas; Karl F Kauffman; Henry E Wang
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors     Volume:  14     ISSN:  1545-0066     ISO Abbreviation:  Prehosp Emerg Care     Publication Date:    2010 Jan-Mar
Date Detail:
Created Date:  2009-12-01     Completed Date:  2010-03-25     Revised Date:  2014-03-13    
Medline Journal Info:
Nlm Unique ID:  9703530     Medline TA:  Prehosp Emerg Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  26-30     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Airway Obstruction / therapy*
Clinical Competence
Emergency Medical Services / methods*
Equipment Failure* / statistics & numerical data
Humans
Intubation, Intratracheal / instrumentation,  standards*
Observation
Prospective Studies
Treatment Failure
Grant Support
ID/Acronym/Agency:
K08 HS013628/HS/AHRQ HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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