Nasal protection prevents nasal pressure injury from nasotracheal intubation

A new study conducted by Hiroshi Hoshijima and team found that nasal pressure damage during nasotracheal intubation is considerably decreased by a nasal protection technique. The findings of this study were published in Medicine Journal.

Nasotracheal intubation is mostly used to maintain long-term artificial breathing and to secure the airway during oral or head and neck surgery. The tracheal tube's constant pressure on the nasal columella and ala during nasotracheal intubation typically results in local ischemia between them. Nasotracheal intubation poses a high risk for nasal pressure damage. In order to ascertain if the adoption of a nose protection strategy (a protective dressing or a modified fastening method for the tracheal tube) lowers the incidence of nasal pressure injury during nasotracheal intubation, researchers conducted this systematic review and meta-analysis.

Three electronic databases were used for the literature searches. DerSimonian and Laird random effects models were used to aggregate the data from all of the eligible trials and perform the computations. The Cochrane Q statistic, the I2 statistic, and the relative risk and 95% confidence interval were used to assess the pooled effect estimates for nasal pressure injury. TSA was also carried out to evaluate the sensitivity to guard against type I mistakes. To determine the frequency of nasal pressure damage based on whether a protective dressing or a modified fixation technique for the tracheal tube was utilized, patients were divided into subgroups.

The key findings of this studies were:

1. Five trials that met the criteria were found in the literature.

2. A nose protection technique considerably decreased the incidence of nasal pressure damage during nasotracheal intubation, according to a meta-analysis of these trials.

3. Due to a small sample size, it was not possible to compute the TSA threshold for futility.

4. Both techniques considerably decreased the frequency of nasal pressure damage during nasotracheal intubation in subgroup analysis.

In conclusion, the frequency of nasal pressure injuries during nasotracheal intubation can be reduced by using a protective bandage or a modified anchoring technique for the tracheal tube. Further research is necessary because the number of samples in our meta-analysis was insufficient for TSA.

Reference:

Hoshijima, H., Mihara, T., Nagumo, T., Sato (Boku), A., Shiga, T., & Mizuta, K. (2022). Nasal protection strategy reduces the incidence of nasal pressure injuries during nasotracheal intubation: Meta-analysis with trial sequential analysis. In Medicine (Vol. 101, Issue 40, p. e30638). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/md.0000000000030638