TY - JOUR
T1 - Prevention of Endotracheal Tube–Related Pressure Injury
T2 - A Systematic Review and Meta-analysis
AU - Moser, Chandler H.
AU - Peeler, Anna
AU - Long, Robert
AU - Schoneboom, Bruce
AU - Budhathoki, Chakra
AU - Pelosi, Paolo P.
AU - Brenner, Michael J.
AU - Pandian, Vinciya
N1 - Funding Information:
FINANCIAL DISCLOSURES This research received financial support from National Institutes of Health grant R01 NIH 5-R017433 (to Dr Pan-dian) for assessment of laryngeal injury after extubation in intensive care unit settings. It was also supported by TriService Nursing Research Program award 11052-N2103GR (to Mr Moser), which was awarded and administered by the Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Publisher Copyright:
© 2022 American Association of Critical-Care Nurses.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Background Hospital-acquired pressure injuries, including those related to airway devices, are a significant source of morbidity in critically ill patients. Objective To determine the incidence of endotracheal tube–related pressure injuries in critically ill patients and to evaluate the effectiveness of interventions designed to prevent injury. Methods MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units that evaluated interventions to reduce endotracheal tube–related pressure injury. Reviewers extracted data on study and patient characteristics, incidence of pressure injury, type and duration of intervention, and outcomes. Risk of bias assessment followed the Cochrane Collaboration’s criteria. Results Twelve studies (5 randomized clinical trials, 3 quasi-experimental, 4 observational) representing 9611 adult and 152 pediatric patients met eligibility criteria. The incidence of pressure injury was 4.2% for orotracheal tubes and 21.1% for nasotracheal tubes. Interventions included anchor devices, serial endotracheal tube assessment or repositioning, and barrier dressings for nasotracheal tubes. Meta-analysis revealed that endotracheal tube stabilization was the most effective individual intervention for preventing pressure injury. Nasal alar barrier dressings decreased the incidence of skin or mucosal injury in patients undergoing nasotracheal intubation, and data on effectiveness of serial assessment and repositioning were inconclusive. Conclusions Airway device–related pressure injuries are common in critically ill patients, and patients with nasotracheal tubes are particularly susceptible to iatrogenic harm. Fastening devices and barrier dressings decrease the incidence of injury. Evidence regarding interventions is limited by lack of stan-dardized assessments.
AB - Background Hospital-acquired pressure injuries, including those related to airway devices, are a significant source of morbidity in critically ill patients. Objective To determine the incidence of endotracheal tube–related pressure injuries in critically ill patients and to evaluate the effectiveness of interventions designed to prevent injury. Methods MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units that evaluated interventions to reduce endotracheal tube–related pressure injury. Reviewers extracted data on study and patient characteristics, incidence of pressure injury, type and duration of intervention, and outcomes. Risk of bias assessment followed the Cochrane Collaboration’s criteria. Results Twelve studies (5 randomized clinical trials, 3 quasi-experimental, 4 observational) representing 9611 adult and 152 pediatric patients met eligibility criteria. The incidence of pressure injury was 4.2% for orotracheal tubes and 21.1% for nasotracheal tubes. Interventions included anchor devices, serial endotracheal tube assessment or repositioning, and barrier dressings for nasotracheal tubes. Meta-analysis revealed that endotracheal tube stabilization was the most effective individual intervention for preventing pressure injury. Nasal alar barrier dressings decreased the incidence of skin or mucosal injury in patients undergoing nasotracheal intubation, and data on effectiveness of serial assessment and repositioning were inconclusive. Conclusions Airway device–related pressure injuries are common in critically ill patients, and patients with nasotracheal tubes are particularly susceptible to iatrogenic harm. Fastening devices and barrier dressings decrease the incidence of injury. Evidence regarding interventions is limited by lack of stan-dardized assessments.
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U2 - 10.4037/ajcc2022644
DO - 10.4037/ajcc2022644
M3 - Review article
C2 - 36045034
AN - SCOPUS:85137069838
SN - 1062-3264
VL - 31
SP - 416
EP - 424
JO - American Journal of Critical Care
JF - American Journal of Critical Care
IS - 5
ER -