Comparative effectiveness of various intubation fixation devices for patients undergoing tracheal intubation in the ICU: A systematic review and network meta-analysis.
Zexi Huang, Nianqi Cui, Yanmin Zheng and 5 others
PMID 42266854WHAT IT FOUND
In ICU patients with a breathing tube through the mouth, overall comparisons did not show clear differences in tube movement or facial pressure injuries among ways to hold the tube.
Tape-and-strap fixation may reduce discomfort compared with dental pads, but evidence is limited.
Key findings
01No fixation device clearly reduced tube displacement compared with dental pads, and the network analysis did not show any device as superior.
02In direct comparisons, tracheal intubation fixators and bandage fixation reduced facial pressure injuries compared with dental pads, but the network analysis did not show clear superiority.
03Tape-and-strap hybrid fixation was more effective than traditional fixation for reducing pain, and it ranked most likely to reduce pain among the five devices.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 16 randomized trials with 1,876 participants were included, and only two trials directly compared catheter displacement. Most trials were rated as possible risk or high risk, and only 15.4% gave enough detail on allocation concealment. All eligible studies were kept in the analysis even when risk of bias was high, to preserve the network. The trials were mostly from China, so the results may not apply to other ICU settings. Funnel plots suggested possible publication bias for tube displacement and facial pressure injury. Pain was measured with a visual scale for device discomfort, not broader pain, and the rankings do not show clear superiority.
Declared interests
The work was funded by the Science Research Foundation of the Chinese Nursing Association. The authors declared no conflict of interest. The funder had no role in the design, conduct, analysis, or manuscript preparation.
The easy way to misread this
Do not conclude that hybrid fixation prevents unplanned extubation. It may reduce discomfort, but tube displacement was not clearly different and unplanned extubation was not an outcome tested.