Non-Cochrane · intervention · PM42266854
Comparative effectiveness of various intubation fixation devices for patients undergoing tracheal intubation in the ICU: A systematic review and network meta-analysis.
Huang Zexi, Cui Nianqi, Zheng Yanmin, et al. · International journal of nursing sciences · 2026 · PubMed · doi:10.1016/j.ijnss.2025.12.009
Findings
Population Adults (18 years or older) undergoing orotracheal intubation in the ICU
66 findings
| Tracheal intubation fixator | Dental pad fixation | Catheter displacement Intensive care units · Node-splitting indirect estimate (Suppl. Table S4) | OR 0.26 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Dental pad fixation (bite block secured with tape or bandage) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 0.05 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Dental pad fixation (bite block secured with tape or bandage) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 3.86 [1.22, 12.28] GRADE not reported 2 studies · 362 participants |
| Tracheal intubation fixator | Dental pad fixation | Catheter displacement Intensive care units · Node-splitting direct estimate (Suppl. Table S4) | OR 0.20 GRADE not reported Studies not reported |
| Tracheal intubation fixator | Dental pad fixation | Pain (VAS, any pain vs none) Intensive care units · Node-splitting indirect estimate (Suppl. Table S6) | OR 0.02 GRADE not reported Studies not reported |
| Tracheal intubation fixator | Dental pad fixation | Facial pressure injury Intensive care units · Node-splitting indirect estimate (Suppl. Table S5) | OR 0.02 GRADE not reported Studies not reported |
| Tracheal intubation fixator | Dental pad fixation | Catheter displacement Intensive care units · Node-splitting network estimate (Suppl. Table S4) | OR 0.22 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 10.58 [2.22, 50.37] GRADE not reported 2 studies · 362 participants |
| Tracheal intubation fixator | Dental pad fixation | Facial pressure injury Intensive care units · Node-splitting direct estimate (Suppl. Table S5) | OR 0.05 GRADE not reported Studies not reported |
| Tracheal intubation fixator | Dental pad fixation | Pain (VAS, any pain vs none) Intensive care units · Node-splitting network estimate (Suppl. Table S6) | OR 0.04 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 0.04 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Dental pad fixation (bite block secured with tape or bandage) | Catheter displacement (any displacement vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 3.92 [0.73, 20.94] GRADE not reported 2 studies · 362 participants |
| Adhesive tape fixation | Dental pad fixation | Pain (VAS, any pain vs none) Intensive care units · Node-splitting network estimate (Suppl. Table S6) | OR 7.90 GRADE not reported Studies not reported |
| Adhesive tape fixation | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 2.00 GRADE not reported Studies not reported |
| Adhesive tape fixation | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 5.08 [1.06, 24.26] GRADE not reported 2 studies · 215 participants |
| Adhesive tape fixation | Dental pad fixation (bite block secured with tape or bandage) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 3.20 [0.72, 14.28] GRADE not reported 1 study · 107 participants |
| Adhesive tape fixation | Dental pad fixation (bite block secured with tape or bandage) | Catheter displacement (any displacement vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 2.31 [0.39, 13.55] GRADE not reported 1 study · 107 participants |
| Adhesive tape fixation | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, indirect estimate | OR 1.60 GRADE not reported Studies not reported |
| Adhesive tape fixation | Dental pad fixation | Facial pressure injury Intensive care units · Node-splitting direct estimate (Suppl. Table S5) | OR 2.80 GRADE not reported Studies not reported |
| Adhesive tape fixation | Dental pad fixation | Catheter displacement Intensive care units · Node-splitting direct estimate (Suppl. Table S4) | OR 2.90 GRADE not reported Studies not reported |
| Adhesive tape fixation | Dental pad fixation | Pain (VAS, any pain vs none) Intensive care units · Node-splitting indirect estimate (Suppl. Table S6) | OR 1.80 GRADE not reported Studies not reported |
| Adhesive tape fixation | Dental pad fixation | Catheter displacement Intensive care units · Node-splitting indirect estimate (Suppl. Table S4) | OR 1.60 GRADE not reported Studies not reported |
| Adhesive tape fixation | Dental pad fixation | Pain (VAS, any pain vs none) Intensive care units · Node-splitting direct estimate (Suppl. Table S6) | OR 50.00 GRADE not reported Studies not reported |
| Adhesive tape fixation | Dental pad fixation | Catheter displacement Intensive care units · Node-splitting network estimate (Suppl. Table S4) | OR 2.00 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Dental pad fixation (bite block secured with tape or bandage) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 1.88 [0.28, 12.42] GRADE not reported 1 study · 80 participants |
| Bandage fixation | Dental pad fixation | Pain (VAS, any pain vs none) Intensive care units · Node-splitting indirect estimate (Suppl. Table S6) | OR 2.30 GRADE not reported Studies not reported |
| Bandage fixation | Dental pad fixation | Catheter displacement Intensive care units · Node-splitting indirect estimate (Suppl. Table S4) | OR 8.90 GRADE not reported Studies not reported |
| Bandage fixation | Dental pad fixation | Catheter displacement Intensive care units · Node-splitting network estimate (Suppl. Table S4) | OR 5.40 GRADE not reported Studies not reported |
| Bandage fixation | Dental pad fixation | Facial pressure injury Intensive care units · Node-splitting indirect estimate (Suppl. Table S5) | OR 9.10 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Dental pad fixation (bite block secured with tape or bandage) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 74.0 GRADE not reported Studies not reported |
| Bandage fixation | Dental pad fixation | Pain (VAS, any pain vs none) Intensive care units · Node-splitting direct estimate (Suppl. Table S6) | OR 11.00 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 4.00 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Dental pad fixation (bite block secured with tape or bandage) | Catheter displacement (any displacement vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 4.00 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 5.40 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 12.33 [2.13, 71.22] GRADE not reported 1 study · 80 participants |
| Bandage fixation (non-adhesive nylon or cotton strap) | Dental pad fixation (bite block secured with tape or bandage) | Catheter displacement (any displacement vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 4.30 [0.76, 24.35] GRADE not reported 2 studies · 188 participants |
| Hybrid fixation (adhesive tapes and straps) | Dental pad fixation (bite block secured with tape or bandage) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 16.27 [3.56, 74.30] GRADE not reported 2 studies · 138 participants |
| Hybrid fixation (adhesive tapes and straps) | Dental pad fixation (bite block secured with tape or bandage) | Catheter displacement (any displacement vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 0.93 [0.04, 20.17] GRADE not reported 1 study · 62 participants |
| Hybrid fixation (adhesive tapes and straps) | Dental pad fixation (bite block secured with tape or bandage) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Direct paired random-effects meta-analysis versus dental pad fixation | OR 9.67 [0.35, 264.31] GRADE not reported 1 study · 62 participants |
| Adhesive tape fixation | Tracheal intubation fixator (commercial endotracheal tube holder) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 0.45 GRADE not reported Studies not reported |
| Adhesive tape fixation | Tracheal intubation fixator (commercial endotracheal tube holder) | Catheter displacement (any displacement vs none) During ICU orotracheal intubation · Node-splitting analysis, indirect estimate | OR 0.06 GRADE not reported Studies not reported |
| Adhesive tape fixation | Tracheal intubation fixator | Catheter displacement Intensive care units · Node-splitting direct estimate (Suppl. Table S4) | OR 1.70 GRADE not reported Studies not reported |
| Adhesive tape fixation | Tracheal intubation fixator (commercial endotracheal tube holder) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, indirect estimate | OR 0.06 GRADE not reported Studies not reported |
| Adhesive tape fixation | Tracheal intubation fixator (commercial endotracheal tube holder) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 1.70 GRADE not reported Studies not reported |
| Adhesive tape fixation | Tracheal intubation fixator | Catheter displacement Intensive care units · Node-splitting network estimate (Suppl. Table S4) | OR 0.45 GRADE not reported Studies not reported |
| Adhesive tape fixation | Tracheal intubation fixator (commercial endotracheal tube holder) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 1.20 GRADE not reported Studies not reported |
| Adhesive tape fixation | Tracheal intubation fixator | Pain (VAS, any pain vs none) Intensive care units · Node-splitting network estimate (Suppl. Table S6) | OR 0.31 GRADE not reported Studies not reported |
| Adhesive tape fixation | Tracheal intubation fixator | Pain (VAS, any pain vs none) Intensive care units · Node-splitting indirect estimate (Suppl. Table S6) | OR 0.07 GRADE not reported Studies not reported |
| Bandage fixation | Adhesive tape fixation | Catheter displacement Intensive care units · Node-splitting network estimate (Suppl. Table S4) | OR 2.70 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Adhesive tape fixation | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 9.10 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Adhesive tape fixation | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 22.00 GRADE not reported Studies not reported |
| Bandage fixation | Adhesive tape fixation | Catheter displacement Intensive care units · Node-splitting indirect estimate (Suppl. Table S4) | OR 0.29 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Adhesive tape fixation | Catheter displacement (any displacement vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 22.0 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Adhesive tape fixation | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 66.00 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Adhesive tape fixation | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 2.70 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Adhesive tape fixation | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, indirect estimate | OR 0.29 GRADE not reported Studies not reported |
| Bandage fixation (non-adhesive nylon or cotton strap) | Adhesive tape fixation | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, indirect estimate | OR 0.34 GRADE not reported Studies not reported |
| Tracheal intubation fixator | Bandage fixation | Facial pressure injury Intensive care units · Node-splitting direct estimate (Suppl. Table S5) | OR 0.05 GRADE not reported Studies not reported |
| Tracheal intubation fixator | Bandage fixation | Facial pressure injury Intensive care units · Node-splitting indirect estimate (Suppl. Table S5) | OR 4.60 GRADE not reported Studies not reported |
| Tracheal intubation fixator | Bandage fixation | Catheter displacement Intensive care units · Node-splitting direct estimate (Suppl. Table S4) | OR 0.05 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Bandage fixation (non-adhesive nylon or cotton strap) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, indirect estimate | OR 19.0 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Bandage fixation (non-adhesive nylon or cotton strap) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, direct estimate | OR 0.49 GRADE not reported Studies not reported |
| Tracheal intubation fixator | Bandage fixation | Catheter displacement Intensive care units · Node-splitting network estimate (Suppl. Table S4) | OR 1.20 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Bandage fixation (non-adhesive nylon or cotton strap) | Facial pressure injury (any injury vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 1.20 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Bandage fixation (non-adhesive nylon or cotton strap) | Catheter displacement (any displacement vs none) During ICU orotracheal intubation · Node-splitting analysis, indirect estimate | OR 4.70 GRADE not reported Studies not reported |
| Tracheal intubation fixator (commercial endotracheal tube holder) | Bandage fixation (non-adhesive nylon or cotton strap) | Pain (VAS, any pain vs none) During ICU orotracheal intubation · Node-splitting analysis, network estimate | OR 2.80 GRADE not reported Studies not reported |
Included primary studies 17
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Chen 2016 matched by author and year (probable) | NR | 3 other reviews | Catheter displacement (any displacement vs none); Facial pressure injury (any injury vs none) | not extracted yet |
| Bahadori 2022 Durapore vs. Hy-Tape for securing endotracheal tubes during general anaesthesia: a prospective randomised controlled non-inferiority trial. PMID:36345922 | 2022 | this review only | Facial pressure injury (any injury vs none) | not extracted yet |
| Chen 2016 DOI:10.3969/j.issn.1671-8283.2016.10.008 | NR | this review only | Catheter displacement (any displacement vs none); Facial pressure injury (any injury vs none) | not extracted yet |
| Chen 2017 [Evaluation of the effect of a new fixation tape for tracheal catheter in intensive care patients]. PMID:28936962 | 2017 | this review only | Catheter displacement (any displacement vs none); Facial pressure injury (any injury vs none); Pain (VAS, any pain vs none) | not extracted yet |
| Genc 2022 The impact of two distinct endotracheal tube fixation on the formation of pressure ulcer in the intensive care unit: A randomised… PMID:35088531 | 2022 | this review only | Facial pressure injury (any injury vs none) | not extracted yet |
| Hu 2009 DOI:10.16460/j.issn1008-9969.2009.02.021 | NR | this review only | Pain (VAS, any pain vs none) | not extracted yet |
| Landsperger 2019 The effect of adhesive tape versus endotracheal tube fastener in critically ill adults: the endotracheal tube securement (ETTS) randomized… PMID:31064406 | 2019 | this review only | Catheter displacement; Facial pressure injury (any injury vs none) | not extracted yet |
| Ma 2014 DOI:10.16460/j.issn1008-9969.2014.19.017 | NR | this review only | Catheter displacement (any displacement vs none) | not extracted yet |
| Miu 2016 DOI:10.16821/j.cnki.hsjx.2016.24.031 | NR | this review only | Facial pressure injury | not extracted yet |
| Niu 2023 Clinical application and evaluation of a new type of tracheal catheter fixation belt. PMID:36480230 | 2023 | this review only | Catheter displacement (any displacement vs none) | not extracted yet |
| Qian 2022 Design and Clinical Application Effect Analysis of a New Type of Oral Fluid Suction Device for Patients with Orotracheal Intubation. PMID:35935331 | 2022 | this review only | Catheter displacement (any displacement vs none); Facial pressure injury (any injury vs none); Pain (VAS, any pain vs none) | not extracted yet |
| Wang 2013 DOI:10.3969/j.issn.1672-9676.2013.13.067 | NR | this review only | Catheter displacement (any displacement vs none); Facial pressure injury (any injury vs none); Pain (VAS, any pain vs none) | not extracted yet |
| Wang 2013 matched by author and year (probable) | NR | this review only | Catheter displacement (any displacement vs none); Facial pressure injury (any injury vs none); Pain (VAS, any pain vs none) | not extracted yet |
| Xie 2017 DOI:10.3969/j.issn.1006-7256.2017.07.049 | NR | this review only | Catheter displacement; Facial pressure injury (any injury vs none); Pain (VAS, any pain vs none) | not extracted yet |
| Xie 2017 Auditory exposure of high-risk infants discharged from the NICU and the impact of social factors. PMID:32017237 | 2020 | this review only | not stated | not extracted yet |
| Zeng 2016 Comparison of Medical Adhesive Tapes in Patients at Risk of Facial Skin Trauma under Anesthesia. PMID:27382368 | 2016 | this review only | Facial pressure injury (any injury vs none) | not extracted yet |
| Zhu 2020 DOI:10.3969/j.issn.1672-9676.2020.14.055 | NR | this review only | Catheter displacement; Facial pressure injury; Pain (VAS, any pain vs none) | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) undergoing orotracheal intubation in the ICU; no neck or facial trauma, oral diseases or skin allergy history | Adult ICU patients with orotracheal intubation, 1,876 participants in 16 RCTs (n=16) |
| Intervention | Tracheal intubation fixators, bandage fixation, adhesive tape fixation, dental pad fixation, hybrid fixation | Tracheal intubation fixator (n=6), dental pad (n=8), adhesive tape (n=8), bandage (n=8), hybrid fixation (n=3) |
| Comparison | One of the other four fixation devices; dental pad fixation designated as the reference (traditional) method | Dental pad fixation as network reference; other devices compared against each other |
| Outcomes | Catheter displacement, facial pressure injury, pain (VAS) | Catheter displacement (n=11 RCTs), facial pressure injury (n=13), pain (n=8) |
| Study designs | RCTs published in Chinese or English | 16 RCTs (15 two-arm, 1 three-arm); 75% conducted in China |
| Timing | Not specified | Intervention duration 4 to 27 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | No | No | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |