title: Comparison of commercial and noncommercial endotracheal tube-securing devices.
abstract: BACKGROUND
  Tracheal intubation is used to establish a secure airway in patients who require mechanical ventilation. Unexpected extubation can have serious complications, including airway trauma and death. Various methods and devices have been developed to maintain endotracheal tube (ETT) security. Associated complications include pressure ulcers due to decreased tissue perfusion. Device consideration includes ease of use, rapid application, and low exerted pressure around the airway.
  
  
  METHODS
  Sixteen ETT holders were evaluated under a series of simulated clinical conditions. ETT security was tested by measuring distance displaced after a tug. Nine of the 16 methods could be evaluated for speed of moving the ETT to the opposite side of the mouth. Sensors located on a mannequin measured applied forces when the head was rotated vertically or horizontally. Data were analyzed using multivariate analysis of variance, with P < .05.
  
  
  RESULTS
  Median displacement of the ETT by the tug test was 0 cm (interquartile range of 0.0-0.10 cm, P < .001). The mean time to move the ETT from one side of the mouth to the other ranged from 1.25 ± 0.2 s to 34.4 ± 3.4 s (P < .001). Forces applied to the face with a vertical head lift ranged from < 0.2 newtons (N) to a maximum of 3.52 N (P < .001). Forces applied to the face with a horizontal rotation ranged from < 0.2 N to 3.52 N (P < .001). Commercial devices produced greater force than noncommercial devices.
  
  
  CONCLUSIONS
  Noncommercial airway holders exert less force on a patient's face than commercial devices. Airway stability is affected by the type of securing method. Many commercial holders allow for rapid but secure movement of the artificial airway from one side of the mouth to the other.
authors.affiliation: Respiratory Care Services, Massachusetts General Hospital, Boston, Massachusetts. dfisher2@partners.org.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Fisher
authors.affiliation: Respiratory Care Services, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chenelle
authors.affiliation: Respiratory Care Services, Massachusetts General Hospital, Boston, Massachusetts. Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Marchese
authors.affiliation: Respiratory Care Services, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Kratohvil
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
mesh_terms: D060666:Airway Extubation; D003132:Commerce; D004867:Equipment Design; D004868:Equipment Failure; D006257:Head; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008348:Manikins; D008422:Materials Testing; D011312:Pressure; D012121:Respiration, Artificial / Q000295:instrumentation*; D012399:Rotation; D053832:Surgical Tape; D013997:Time Factors; D013996:Time and Motion Studies
keywords: airway holder; endotracheal tube; mechanical ventilation; secure airway; tracheal intubation