Nasal protection strategy reduces the incidence of nasal pressure injuries during nasotracheal intubation: Meta-analysis with trial sequential analysis

BACKGROUND

Nasal pressure injury is a serious problem during nasotracheal intubation. We performed this systematic review and meta-analysis to determine whether use of a nasal protection strategy (a protective dressing or a modified fixation method for the tracheal tube) reduces the incidence of nasal pressure injury during nasotracheal intubation.

METHODS

Literature searches were performed using three electronic databases. Data from each of the eligible trials were combined, and calculations were made using DerSimonian and Laird random effects models. The pooled effect estimates for nasal pressure injury were evaluated using the relative risk and 95% confidence interval, the Cochrane Q statistic, and the I2 statistic. We also performed trial sequential analysis (TSA) to assess sensitivity to prevent type I error. We separated patients into subgroups to analyze the incidence of nasal pressure injury according to whether a protective dressing or a modified fixation method for the tracheal tube was used.

RESULTS

The literature search yielded five eligible trials. Meta-analysis of these trials showed that a nasal protection strategy significantly reduced the incidence of nasal pressure injury during nasotracheal intubation (relative risk (RR) 0.34; 95% confidence interval (CI) 0.21-0.56; P < .0001; Cochrane's Q = 5.86, I2 = 32%). The TSA boundary for futility could not be calculated because of an insufficient sample size. In subgroup analysis, both methods significantly reduced the incidence of nasal pressure injury during nasotracheal intubation.

CONCLUSIONS

The findings of this meta-analysis suggest that a nasal protection strategy significantly reduces the incidence of nasal pressure injury during nasotracheal intubation. During nasotracheal intubation, the use of a protective dressing or modified fixation method for the tracheal tube can prevent to the incidence of nasal pressure injuries. However, the number of samples in our meta-analysis was too small for TSA and further studies are required.

TRIALS REGISTRATION

PROSPERO (International Prospective Register of Systematic Reviews; registration number 252091).

Prophylactic sacral protective dressings' effect on preventing pressure injury: A meta-analysis

We performed a meta-analysis to evaluate the effect of prophylactic sacral protective dressings on preventing pressure injury. A systematic literature search up to July 2021 was performed, and 11 studies included 5150 community or hospital-based adult subjects requiring care at the start of the study; 2832 of them were using sacral protective dressings and 2318 were given standard care with no sacral protective dressings. They were reporting relationships between the effects of prophylactic sacral protective dressings on preventing pressure injury. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of prophylactic sacral protective dressings on preventing pressure injury using the dichotomous method with a random or fixed-effect model. Sacral protective dressings had a significantly lower incidence of pressure injuries (OR, 0.39; 95% CI, 0.28-0.53, P < .001) compared with standard care with no sacral protective dressings in community- or hospital-based adult subjects requiring care. Sacral protective dressings had a significantly lower incidence of pressure injuries compared with standard care with no sacral protective dressings in community- or hospital-based adult subjects requiring care. Further studies are needed to confirm these findings.