10-Successful treatment of endotracheal Critical Care Open Access intubation-related lip pressure injury using a self-developed fixation device

Zhang et al. Critical Care (2023) 27:298 Critical Care<a href="https://doi.org/10.1186/s13054-023-04577-5">https://doi.org/10.1186/s13054-023-04577-5</a><img src="/media/202408//1724856373.457503.png" /><img src="/media/202408//1724856373.6312692.png" />	CORRESPONDENCE Open AccessSuccessful treatment of endotrachealintubation-related lip pressure injury using a self-developed fxation deviceQibing Zhang1†, Xiaodong Zhang1†, Chunrong Han1†, Jiqin You2, Yunxia Zhao1, Rong Xu1, Shiyan Zhao1 and Yan Geng1*Dear editor,Orotracheal intubation is the most common method for establishing artifcial airways and plays a signifcant role in rescuing critically ill patients <a href="#bookmark1">[1</a>]. However, orotra- cheal intubation is associated with several complications, including iatrogenic mucocutaneous damage, catheter dislodgement, and tooth loosening <a href="#bookmark1">[1</a>, <a href="#bookmark2">2</a>]. Tese compli- cations may result in prolonged hospitalisation, increased infection opportunities, and burden the healthcare sys- tem and society <a href="#bookmark2">[2</a>, <a href="#bookmark3">3</a>]. Terefore, proper endotracheal tube fxation is essential for preventing complications in patients undergoing orotracheal intubation. Herein, we report the successful treatment of a 79-year-old patient with lip pressure injury using a novel self-developed mask endotracheal tube fxation device (utility model patent of China, ZL 2022 2 1745523.5; Fig. <a href="#bookmark4">1</a>A). Te fxation device comprises a triangular headband, base, connect- ing bridge, fxation nut, and bite block (Fig. <a href="#bookmark4">1</a>B). Te base comprises a mask frame and silicone pad. Te connecting bridge is printed using a photosensitive resin. Te fxa- tion nut is adapted from a traditional endotracheal tube fxator.†Qibing Zhang, Xiaodong Zhang, and Chunrong Han contributed equally to this work and should be regarded as co-frst authors.*Correspondence: Yan Genggengyan2004@163.com1 Nanjing Lishui People’s Hospitial (Zhongda Hospital Lishui Branch), Southeast University, Nanjing 211200, China2 The Central Hospital of Xuzhou, Xuzhou 221000, ChinaA 79-year-old Chinese woman was admitted to an intensive care unit with dyspnoea. She had a history of diabetes mellitus, hypertension, and cerebral infarction. Using a traditional endotracheal tube fxator, orotra- cheal intubation connected to a ventilator for assisted breathing, and oral care was provided every 6 h. Six days later, three pressure injuries were observed on her lips and the surrounding regions (Fig. <a href="#bookmark4">1</a>C). Pathologi- cal examination of tissue samples revealed epidermal fractures, focal pseudoepithelioma-like hyperplasia, dermal vascular expansion, acute and chronic infam- matory cell infltration in the epidermis and dermis, parakeratosis of the shed squamous epithelial cell mass, bacterial colonies in the infammatory exudative, and necrotic tissue (Fig. <a href="#bookmark4">1</a>D). Additionally, tissue-print cytology indicated infammatory exudation, necrosis, and large amounts of red blood cells (Fig. <a href="#bookmark4">1</a>E). Sus- tained pressure above a threshold can cause prolonged ischaemia and lead to tissue necrosis [<a href="#bookmark5">4</a>]. Te pressure wounds were likely initially colonised by bacterial fora and that a bacterial imbalance resulted in a bacterial infection [<a href="#bookmark3">3</a>]. Bacterial infections impede wound heal- ing, especially in diabetic patients [<a href="#bookmark6">5</a>]. To prevent fur- ther lip pressure injury and considering the patient’s history of diabetes mellitus, we replaced the tradi- tional endotracheal tube fxator with a self-developed fxation device. After explaining the procedure to the patient’s husband, we placed the self-developed fxa- tion device. On the third day after device replacement, the ruptured regions surrounding the right upper lip<img src="/media/202408//1724856373.7288918.png" />BMC© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, whichpermits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images orother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of thislicence, visit <a href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</a>. The Creative Commons Public Domain Dedication waiver (<a href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativeco</a> <a href="http://creativecommons.org/publicdomain/zero/1.0/">mmons.org/publicdomain/zero/1.0/</a>) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Zhang et al. Critical Care (2023) 27:298 Page 2 of 3<img src="/media/202408//1724856373.767433.jpeg" /><a id="bookmark4"></a>Fig. 1 A Photograph of the patient wearing the self-developed endotracheal tube fxation device. B Structure diagram of the self-developedmask endotracheal tube fxation device. C Lip pressure injuries before application of the self-developed mask endotracheal tube fxationdevice. D Histopathological image of damaged lip tissue before application of the self-developed mask endotracheal tube fxation device (the enlarged part in the image showed bacterial colonies). E Cytopathological image of damaged lip tissue before application of the self-developed mask endotracheal tube fxation device. F Slightly improved lip pressure injuries on the third day after device replacement. G Cytopathological image of damaged lip tissue on the third day after device replacement. H Signifcantly improved lip pressure injuries after device replacement. I Cytopathological image of damaged lip tissue after device replacementwas smaller than those earlier (Fig. <a href="#bookmark4">1</a>F). Moreover, tissue-print cytology showed decreased infammatory exudation and necrosis (Fig. <a href="#bookmark4">1</a>G). On the ffth day after device replacement, the upper edge of the lip peak and the vermilion border of the right lower lip were com- pletely healed, and the ruptured regions surrounding the right upper lip was signifcantly smaller (Fig. <a href="#bookmark4">1</a>H). Tissue-print cytology indicated a signifcant reductionin infammatory exudation and necrosis, without anybacterial colonies or repaired epithelial cells (F<a href="#bookmark4">i</a>g. <a href="#bookmark4">1</a>I). Te endotracheal tube did not dislodge, and no new pressure injury occurred while the self-developed fxa- tion device was in place.To the best of our knowledge, this is the frst report of a patient with lip pressure injury treated with this novel endotracheal tube fxation device combined with histopathological analyses. Compared with the tradi- tional endotracheal tube fxator, our new device hastwo advantages. First, it avoids the perioral tissues, improves the labial blood circulation, and promotes the repair of pressure injury. Second, it increases the con- tact area on the face, thus reducing the pressure per unit area and preventing pressure injuries. Our report introduces a novel endotracheal tube fxation device that is safe and useful for nursing patients undergoing orotracheal intubation.AcknowledgementsNot applicable.Author contributionsQBZ,XDZ, and CRH wrote the manuscript,YXZ and RX edited the manu-script, and JQY and SYZ dealt with the fgures. YG designed the study andreviewed the manuscript. All authors read and approved the fnal manuscript.FundingSupported by Science Foundation of Nanjing Lishui People’s Hospital,Zhongda Hospital Lishui Branch, Southeast University (Project No.: LY202102).Zhang et al. Critical Care (2023) 27:298 Page 3 of 3Availability of data and materialsThe datasets used and/or analysed during the current study are avail- able from the corresponding author on reasonable request.DeclarationsEthics approval and consent to participateThe study was approved by the Institutional Review Board of Nanjing Lishui People’s Hospital. The patient provided their written informed consent toparticipate in this study.Consent for publicationThe authors declare to have informed consent of the patient to publish the image.Competing interestsThe authors have disclosed that they do not have any conficts of interest.Received: 9 May 2023 Accepted: 11 July 2023published online:24July2023 References<a id="bookmark1"></a>1. 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