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

Abstract

Background: An endotracheal tube (ETT) can be securely positioned using a holder or traditional securing method. The holder is a one-piece moulded design, and traditional securing methods usually involve manual fixation using adhesive tape or bandages. ETT holders are superior to traditional securing methods in reducing medical device-related pressure injuries (MDRPIs) and the incidence of tube dislodgement. However, evidence from previous meta-analyses is highly heterogeneous. Aim: To compare the efficacy of ETT holders and traditional securing methods through a systematic review and meta-analysis of MDRPIs and dislodgement rates. Study Design: Four major databases were searched for relevant randomised controlled trials (RCTs) and non-RCTs. Two authors independently extracted data and assessed the quality of the studies. A meta-analysis was conducted using a random-effects model to estimate the risk ratios and risk differences with 95% confidence intervals. The primary and secondary outcomes were the total number of MDRPIs and tube dislodgements, respectively. Subgroup analyses were performed based on the severity of the condition and nutritional status. Results: A systematic search yielded 3737 references, among which seven met the inclusion criteria. These included three RCTs, two quasi-experimental cohorts and two observational cohorts (n = 3025). Pooled analyses showed a significant reduction in total MDRPI risk and a decreasing trend of composite tube dislodgements for ETT holders compared with traditional securing methods. Subgroup analysis indicated that ETT holders were less effective than traditional securing methods in preventing MDRPIs in patients who were not malnourished or with less severe conditions. Conclusion: Compared with traditional securing methods, ETT holders significantly reduced MDRPI incidence and showed a decreasing trend in dislodgement. However, these effects were not evident in patients with less severe conditions or in those who were not malnourished. Relevance to Clinical Practice: This study highlights that ETT holders significantly reduced MDRPIs, particularly in patients with more severe disease (APACHE II score ≥ 20). Unplanned dislodgements were consistently less frequent with ETT holders; however, the preventive effect on MDRPIs was less evident in patients with less severe disease or better nutritional status. Therefore, disease severity and nutritional status should guide the choice of ETT securement methods and support ICU nurses in enhancing airway safety, minimising complications and standardising care.