Ask an answerable question (PICO)：
Approximately 67% of critically ill adults requiring endotracheal intubation in intensive care unit. There are many potential complications during endotracheal tube intubation, such as: swallowing impairment, opening mouth and reduction of production saliva, which increase the pathogenic bacteria in oral cavity, resulting in dry oral mucosa and irritates oral mucosa by pressure.
Traditional endotracheal tube securement techniques with adhesive tape or cotton rope, these was inconvenience to reposition the tube, which might leads poor circulation and caused facial skin tears, every patient has average two lesions, irritants of oral mucosa were most common area reported. Before implement intervention, facial skin tears and irritants oral mucosa were 40.2%, most irritant regions were corners of mouth 50.1% and lip 20%.
Endotracheal tube fixator could reduce the pressure to contact skin and oral mucosa, better sight to perform oral care, reduce ventilator-associated pneumonia. Endotracheal tube fixation to be more beneficial than traditional fixation methods, this study aims to improve the quality of clinical care to reduce complications among critically ill adults undergoing endotracheal intubation.
The Method and Analysis of Literature Review：
This study builds up a question with PICO related Chinese and English keywords, synonyms, cut-off words. According to the keywords (MeSH) and their synonyms. Using Boolean Logic to develop strategy to search the database since January 1990 till December 2019. Based on five selected articles in accordance with PICO were reviewed based on the inclusion and exclusion criteria.
Critical Appraisal：
The Critical Appraisal Skills Programme (CASP, 2019) and level of Evidence published by CEBM(Oxford University, 2011) was used to appraise the quality of five reviewed studies. Five RCTs literatures were Level 2, the searched literature supports securement of an endotracheal tube with a tube fixator resulted in a lower incidence of and fewer patients experiencing lip ulcers, endotracheal tube dislodgements, or facial skin tears compared to securement with adhesive tape or cotton rope. This study is to evaluate the safety and efficacy of endotracheal tube securement techniques, in comparing the effect of adhesive tape versus endotracheal tube fixator on complications.
Clinical Application of Evidence：
This study assessed total of 16 patients in August 2019, patients with 12 male and 4 female, 40.2% of irritants of oral mucosa was noted before implement of intervention, the most common were found in corners of mouth (50.1%), lips (20%).Patients were randomly allocated in single-blind manner. All patients were underwent with similar nursing care, with regular monitoring skin and oral mucosa status, nursing care will be assessed by three-shift staff nurses, to record both groups’ oral mucosa and facial ulcer conditions.
Evaluation of Effectiveness：
This study was carried out with 36 Patients admitted to the MICU from 10 August 2019 to12 October 2019, 20 were randomized in control groups, 12 males and 8 in females, the average aged were 60.4 years old. 16 were randomized in experimental group, 12 males and in females, the average aged were 62.2 years old. Post intervention, a composite of presence irritant of oral mucosa fixator group 2.8%, cotton rope group16.7%, p =0.06; a composite of presence salivary changes fixator group8.3%, cotton rope group19.4%, p =0.05. facial skin tears p =0.04. Other results has no statistically significant.
Conclusions and Recommendations：
In conclusion, this study has demonstrated critically ill patients, securement of an endotracheal tube with a tube fixator has resulted in a lower incidence of lip ulcer, skin tears reported compared to cotton rope groups. During interview with staff nurses, has reported better oral sight to perform oral hygiene. This study suggested securing endotracheal tube with tube fixator earlier, which has showed better effect for fewer patients to experience oral mucosa ulcer and pressure ulcer incidences, which enhance to perform optimal nursing care and ensure patient comfort and safety care.
