Endotracheal tube holders and the prone position: a cause for concern--reply.

cer cachexia, predisposing him to skin integrity issues (Fig. 3). Others have noted similar issues, and Jackson et al5 proposed specific padding of the head and face to reduce ulcers during prone positioning. Therapists should be cognizant of the potential for these types of facial ulcers (usually associated with mask ventilation), which have been identified by Medicare as avoidable complications.6 Facial edema associated with the prone position clearly increases the risk of airway complications regardless of the method of tube fixation. Clinicians should be vigilant to maintain airway position and prevent skin breakdown. The data obtained by Fisher et al1 and our observations urge extreme caution during use of commercially available tube-fixation devices for patients placed in the prone position.