# Comparison of 3M Reston™ Self-Adhesive Foam Pad and 3M Microfoam™ Surgical Tape in Preventing Nasal Pressure Injuries Associated With Nasotracheal Intubation: A Randomized Controlled Trial

## TL;DR

This study compares two 3M products to prevent nasal injuries from intubation, finding no significant difference but suggesting one may be better for sensitive skin.

## Contribution

A randomized controlled trial comparing two 3M products for preventing nasal pressure injuries during nasotracheal intubation.

## Key findings

- The 3MR group had a higher proportion of patients with no nasal pressure injuries compared to the 3MM group.
- 3MR showed a tendency for fewer tube-induced erythema and better pressure distribution, though differences were not statistically significant.
- No significant differences were found in pressure measurements or nostril-tube diameter differences between the two groups.

## Abstract

Background: Nasotracheal intubation (NTI) is widely used in dental and maxillofacial surgeries to secure the airway while maintaining an unobstructed surgical field. However, NTI is associated with complications such as nasal bleeding, bacteremia, and retropharyngeal perforation. Among these, medical device-related pressure injuries (MDRPIs) caused by nasotracheal tubes are a significant concern. These injuries range from erythema to severe necrosis and can lead to postoperative pain, aesthetic concerns, and prolonged treatment. 3M Microfoam™ surgical tape (3MM; 3M Japan Limited, Shinagawa-ku, Tokyo) has been shown to effectively reduce the risk of nasal pressure injuries. However, its direct application to the skin can irritate, limiting its use in patients with sensitive skin. 3M Reston™ self-adhesive foam pads (3MR; 3M Japan Limited) are constructed using a breathable sponge designed to distribute pressure evenly. They are applied to the medical device rather than directly to the skin. This study aimed to compare the effectiveness of 3MR and 3MM in preventing nasal pressure injuries during NTI.

Methods: A randomized, double-blind prospective study was conducted with 144 patients who underwent general anesthesia with NTI for oral and maxillofacial surgery. Patients were randomly assigned to receive nasal alar protection with either 3MR or 3MM, both of which were attached to the endotracheal tube. The primary outcome was the incidence of nasal pressure injuries. These were classified as tube imprint, tube-induced erythema, and protective material-induced erythema. Those with no nasal pressure injuries constituted a fourth group classed as no imprint or erythema. The secondary outcomes were the pressure between the tube and the nasal alar (PTN) and the difference between the nostril diameter and the outer diameter of the intubation tube.

Results: Among the 140 patients analyzed, the proportion of patients with no imprint or erythema was higher in the 3MR (45 patients) than the 3MM (33 patients) group. The incidence of tube-induced erythema was lower in the 3MR group, but protective material-induced erythema was slightly higher in the 3MM group. However, the differences between the groups were not statistically significant (p = 0.66). The median PTN was 51 (30.1-75.9) g in the 3MR group and 58.1 (36.1-116.8) g in the 3MM group, which was not a significant difference (p = 0.08). The difference between nostril diameter and the outer diameter of the intubation tube was similar in both groups (p = 0.73).

Conclusion: Although no statistically significant differences between the 3MR and 3MM groups were observed in this study, the 3MR group showed a tendency to fewer pressure injuries and better pressure distribution. Given the importance of even pressure distribution to the prevention of MDRPIs, 3MR may be a moderately better alternative to 3MM for patients at high risk of nasal pressure injuries. Further studies with larger sample sizes and long-term follow-up are necessary to fully evaluate the clinical benefits of 3MR.