title: Shifts in endotracheal tube position due to chest compressions: a simulation comparison by fixation method.
abstract: BACKGROUND
  Endotracheal tube placement during resuscitation is important for definite tracheal protection. Accidental extubation due to endotracheal tube displacement is a rare event that can result in severe complications.
  
  
  OBJECTIVE
  This study evaluated how endotracheal tube displacement is affected by tape vs. tube holder fixation using a manikin and auto-chest compression machine simulation.
  
  
  METHODS
  The endotracheal tube was placed in either a shallow or a deep position, with the tube cuff at the center of the glottis or 26 cm from the incisors in an advanced lifesaving simulator. Trials were performed five times in each setting with: no fixation; Durapore® tape fixation; Multipore® tape fixation; and Thomas tube holder® fixation. After 10 min of automated chest compressions, endotracheal tube shift was measured. Statistical analysis was performed with one-way repeated analysis of variance or χ(2) test, with p < 0.05 considered significant.
  
  
  RESULTS
  In the shallow setting, endotracheal tube extubation occurred in all trials with no fixation, Durapore, and Multipore. In contrast, no extubation occurred in the Tube holder trials (p < 0.05). In the deep setting, no extubation was confirmed in any trial. Relative to no fixation (0.56 ± 0.11 cm), endotracheal tube shift was significantly less in the Durapore tape, Multipore tape, and Tube holder groups (p < 0.05). Of the three fixation methods, Tube holder (0.04 ± 0.05 cm) showed significantly less shift (p < 0.05) relative to Durapore (0.28 ± 0.04 cm) and Multipore (0.32 ± 0.08 cm).
  
  
  CONCLUSIONS
  Endotracheal tube displacement occurs less with Tube holder fixation than with Durapore tape or Multipore tape during simulation of continuous chest compressions.
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Komasawa
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Ohchi
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D016887:Cardiopulmonary Resuscitation; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D016544:Patient Simulation; D053832:Surgical Tape
keywords: chest compression; endotracheal tube; position shift; simulation; tape fixation; tube fixation