Comparative Efficacy of Endotracheal Tube Holders Versus Traditional Securing Methods in the Intensive Care Unit: A Systematic Review and Meta-Analysis.

The pooled primary result had very high inconsistency between studies (I2 = 94%), and sensitivity analyses did not remove it. The certainty was downgraded to very low or low because of risk of bias, inconsistency and imprecision. Over 50% of the included studies had a high risk of bias, and two randomised trials had a high risk of bias because of missing outcome data. Only seven studies were included: three randomised trials, two quasi-experimental studies and two observational cohort studies. The subgroup showing higher pressure injury risk with holders in non-malnourished patients came from two studies, and most of the data came from one study. Repositioning frequency differed between groups, every 2 hours with holders and every 6 hours with traditional methods, which could affect pressure injury risk. Differences in oral care, timing of securement changes and other nursing protocols were not sufficiently accounted for. Commercial holders were not examined for fit across different facial shapes and sizes. The protocol was registered after searches had commenced, and the authors acknowledged its retrospective nature.

Do not conclude that ETT holders are safer for every intubated ICU patient. The overall pressure injury result was positive but very low certainty and highly inconsistent, and in patients without malnutrition holders were associated with a significant increase in total pressure injuries compared with traditional methods.