Novel breathing tube helps prevent mouth injuries in intubated patients

A novel nested tracheal tube device that reduces localized pressure on oral tissues during mechanical ventilation appears to mitigate the risk of mucosal membrane pressure injuries (MMPIs) and improve overall oral health outcomes.

Developed by researchers from The Affiliated Hospital of Jiaxing University in Jiaxing, China, the device applies a nested design, in which the bite block surrounds the breathing tube. It also includes a buckle that prevents the tube from moving and a strap that fixes the device into place.

With standard endotracheal tubes, the tube and the bite block sit side-by-side. This configuration, according to the researchers, creates uneven pressure points in the oral cavity, leading to reduced local blood flow, tissue hypoxia, and subsequent tissue damage that, in turn, promote MMPIs.

“MMPIs are challenging to heal, prone to recurrence, and can severely impair oral function, increasing the risk of complications like infections and tissue adhesion. As a result, MMPI prolongs hospital stays, raises healthcare costs, and negatively impacts patient outcomes,” they noted.

“The advantages of the nested tracheal tube lie in its ability to retain the basic functions of both the endotracheal tube and bite block while optimizing the spatial arrangement within the patient’s oral cavity. This reduces the space occupied by the device, thereby decreasing pressure on the oral mucosa. In addition, the nested design enlarges the operative and visual space during oral care, enhancing the effectiveness of oral hygiene maintenance,” the researchers explained.

To test whether the nested tracheal tube could reduce MMPIs and improve oral health outcomes in mechanically ventilated patients, the researchers conducted an intervention study involving 151 patients who had been intubated for more than 48 h. These patients were randomly assigned to receive the nested tracheal tube device (intervention group, n=75) or the standard endotracheal tube with bite block (control group, n=76).

The primary outcome of MMPI occurred in fewer patients in the intervention group than in the control group (2.67 percent vs 17.11 percent; p=0.003). In addition, the intervention group had significantly better Beck Oral Health Scores (p=0.003) and plaque index (p=0.044), indicating improvements in oral function and hygiene. [Int Wound J 2025;22:e70701]

“Patients undergoing orotracheal intubation often have multiple open pathways in the oral cavity, which can hinder normal mucosal hydration and reduce the production of antimicrobial substances. In addition, intubated patients often experience incomplete oral wiping, making it difficult to thoroughly remove secretions, leading to bacterial growth,” the researchers noted.

Taken together, the findings of the study confirm that the nested tracheal tube can “reduce the difficulty of oral care, allow for relative space expansion, facilitate the insertion of oral care brushes and swabs, and improve the efficacy of oral rinsing and secretion removal,” in turn, reducing the incidence of MMPI, they said.