Endotracheal Tube Repositioning Frequency for Preventing Oral Mucosal Pressure Injuries in Intensive Care Units: A Randomised Controlled Trial Study Protocol
Nursing in Critical Care, vol.31, no.4, 2026 (SCI-Expanded, SSCI, Scopus)
- Publication Type: Article / Article
- Volume: 31 Issue: 4
- Publication Date: 2026
- Doi Number: 10.1111/nicc.70529
- Journal Name: Nursing in Critical Care
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Keywords: critical care nursing, equipment and supplies, intubation, mouth mucosa, patient safety, pressure ulcer
- Hacettepe University Affiliated: Yes
Abstract
Background: Endotracheal tubes (ETTs) exert sustained pressure and friction on the oral mucosa, placing mechanically ventilated intensive care unit (ICU) patients at increased risk of mucosal membrane pressure injuries (MMPIs). Aim: To compare the effect of 4-h and 8-h ETT repositioning intervals on the prevention of oral MMPIs in adult ICU patients receiving invasive mechanical ventilation (MV). Methods: This study is designed as an analyst-blinded, parallel-group randomised controlled trial. Adult ICU patients receiving invasive MV via an oral ETT and with Acute Physiology and Chronic Health Evaluation System (APACHE II) scores ≤ 24 will be randomised (1:1) to either 4-h or 8-h ETT repositioning intervals, with stratification by APACHE II score (≤ 20 and 21–24). The primary outcome is the development of oral MMPIs during a 14 day follow-up period or until extubation, tracheostomy, transfer or death, assessed using the Reaper Oral Mucosa Pressure Injury Scale–TR. Secondary outcomes include the timing, severity, and anatomical location of MMPIs. Results: The primary hypothesis is that a 4-h ETT repositioning interval will significantly reduce the incidence of oral MMPIs compared to an 8-h interval. It is anticipated that more frequent repositioning will better preserve mucosal integrity and improve patient comfort. These results are expected to provide evidence-based guidance for standardizing nursing-led ETT care protocols in ICU. Relevance for Clinical Practice: By examining ETT repositioning intervals in relation to disease severity, this study may support more standardised and patient-centred preventive strategies and contribute to safer, more efficient nursing care in intensive care settings. Trial Registration: The Clinical Trial Registration number (Unique Protocol ID) is NCT07390162.