Clamping of the endotracheal tube to preserve the level of PEEP during disconnection from the ventilation circuit – a survey on routine practice

Clamping of the endotracheal tube during disconnection from the ventilatory circuit appears to be commonly used to prevent abrupt loss of positive end-expiratory pressure (PEEP) in invasively ventilated patients. Despite its physiological rationale, this maneuver is not addressed in major guidelines, and data on its prevalence of use and safety are lacking. Objective: To assess the prevalence of endotracheal tube clamping during ventilator disconnection, describe clinical situations in which it is applied and explore reported adverse events associated with its use. We conducted a cross-sectional, anonymized electronic survey among members of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI). A total of 1,344 participants completed the survey. Overall, 87% reported using the clamping maneuver at least occasionally. In only 7.6% of cases, its use was based on local guidelines or standard operating procedures. Clamping was applied across different ventilation modes and with various types of clamps. A total of 11.4% of respondents reported having observed adverse events temporally associated with the maneuver, including airway device damage. Endotracheal tube clamping during ventilator disconnection appears to be a widespread but largely non-standardized clinical practice. Reported safety concerns underscore the need for systematic evaluation of its clinical benefits and risks, as well as for the development of evidence-based recommendations and standardized training concepts. The study was registered at the German Clinical Trials Register on November 3, 2025, registration number DRKS00038337 at https://www.drks.de/DRKS00038337.