Evidence map›Paper›PMID 41131854›Full record

SynthesisNursing in critical care2025

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

Shu-Fen Lu, Wen-Ju Yang, Shu-He Huang, Shin-Shang Chou, Shang-Sin Shiu, Man-Jyun Chen, Ching-Ching Sheng, Ping-Han Hsieh

Abstract readComparative StudyMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Nursing in critical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Shu-Fen LuDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.ORCID https://orcid.org/0009-0005-9584-9764
Wen-Ju YangDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
Shu-He HuangDepartment of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Shin-Shang ChouDepartment of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Shang-Sin ShiuDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
Man-Jyun ChenDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
Ching-Ching ShengDepartment of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
Ping-Han HsiehDivision of Gastroenterology and Hepatology, Department of Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.ORCID https://orcid.org/0000-0002-6070-0178

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAn 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.

aimTo compare the efficacy of ETT holders and traditional securing methods through a systematic review and meta-analysis of MDRPIs and dislodgement rates. STUDY

designFour 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.

resultsA 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.

conclusionCompared 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.

Indexed as

Intensive Care UnitsIntubation, IntratrachealPressure UlcerHumansAnchorFastendotracheal tube holderendotracheal tube securing methodmedical device‐related pressure injurymeta‐analysis

Identifiers

PMID41131854
PMCPMC12570123

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.