The effects of oral vs nasal intubation on endotracheal tube complications in cardiac patients

Abstract

Objective: To test the hypothesis that nasal endotracheal tubes are more secure and associated with fewer complications than oral endotracheal tubes. This involves establishing the incidence of specific endotracheal tube complications between cardiac patients who are intubated via the oral and nasal route. In addition, a secondary objective is to identify specific risk groups that could benefit from a change in practice or implementation of guidelines. Design: A retrospective chart review of 100 patients who were admitted to the Pediatric Cardiac Intensive Care Unit with an endotracheal tube in place was performed. Patients involved in this preliminary study were selected from a larger patient population admitted to Boston Children’s Hospital during the fiscal year of 2011 (October 1, 2010 through September 30, 2011). Variables that were collected include: gender, type of mechanical ventilation, reasons for admission, RACHS-1 scores, outcome of respiratory support, age and weight of patients, duration of ventilation, reason for ventilation, cuffed vs. un-cuffed ETT, size of ETT, initial tube depth, route of intubation, location of intubation, duration of ventilation, CICU and hospital length of stay, and inotropic scores. The specific complications that were analyzed were: inadequate ETT positioning or securing with the need for re-adjustment, accidental or unplanned extubations, device related pressure ulcers and skin breakdown, and feeding problems related to dysphagia. The Z-test was used to determine if the difference in rate of complications between cardiac patients who were orally intubated and cardiac patients who were nasally intubated was statistically significant. The Fisher’s Exact test was also used to confirm the z-test since the sample size was relatively small. Finally, a multi-variable regression with select variables was performed to observe possible confounding factors. The Fisher’s Exact test and Mann-Whitney U-test were used to determine which covariates would be included in the multivariable regression. [TRUNCATED]