Minhua Hu, Jiajia Hu, Peng Sun, Hongyan Zheng, Mingyang Zhang

The First Department of Surgical Anesthesiology, Zhongshan People’s Hospital, Zhongshan, Guangdong, 528403, People’s Republic of China

Correspondence: Minhua Hu, The First Department of Surgical Anesthesiology, Zhongshan People’s Hospital, 2 Sun Wen East Road, Zhongshan, Guangdong, People’s Republic of China, Email huminhuamail@163.com Mingyang Zhang, The First Department of Surgical Anesthesiology, Zhongshan People’s Hospital, 2 Sun Wen East Road, Zhongshan, Guangdong, People’s Republic of China, Email jdzmy2010@163.com

Objective: The aim of this study was to summarize the best evidence for the prevention and management of medical adhesive-related skin injury and to provide a scientific basis for the facial skin care of healthcare professionals and patients undergoing tracheal intubation.
Methods: Following the “ 6S” pyramid model, the literature on the prevention and management of adhesive-associated skin lesions was searched from top to bottom of the guideline website, relevant professional association websites, and Chinese and English databases. The time frame of the search was from the creation of the repository to August 10, 2024. Evidence consolidation was completed in September 2024. The quality of the included studies was assessed, and key evidence was extracted and summarized.
Results: One guideline, five expert consensus reports, three evidence summaries, one cohort study, and two randomized controlled trials were included. Finally, 30 key evidence items were extracted from 7 areas: risk factor identification, skin assessment, selection and use of medical adhesives, skin care, use of skin protection products and removers, pain management, and education and training. The evidence base is characterized by a high proportion of expert consensus (Level 5, 20%) and case-series evidence (Level 4, 60%), reflecting the current lack of robust RCTs in MARSI prevention for intubated patients. However, 73.3% of recommendations carry Grade A strength, supported by either consistent expert consensus or at least one high-quality RCT, providing a solid foundation for clinical implementation. Future research should prioritize large-scale RCTs to validate interventions in diverse populations.
Conclusion: The best evidence for the prevention and management of medical adhesive-associated skin breakdown summarized in this study can be used as a scientific reference for practical nursing care and provide direction for healthcare teams as well as for the care of the facial skin of patients undergoing endotracheal intubation.
Plain Language Summary: risk factor identification, skin assessment, selection and use of medical adhesives, skin care, use of skin protection products and removers, pain management, and education and training. These 7 areas summarize the best evidence to guide healthcare professionals and facial skin care for tracheally intubated patients.

Keywords: medical adhesives, skin injuries, skin tears, medical adhesive, MARSI, prevention, evidence-based care, evidence summary