Optimal patient safety, with reduced complications and improved outcomes, is the goal for all patients, especially for those requiring life sustaining breathing tubes. One of the main patient safety issues associated with airway management is when a patient’s life sustaining breathing tube is dislodged (known as an unplanned extubation), which can lead to vocal cord injury, hypoxemia, cardiovascular instability, severe brain injury, and death. This is typically due to inadequate securement of the endotracheal tube. However, the process of securing the endotracheal tube itself can lead to other patient safety issues, including pressure injuries. Both tube dislodgement and medical device-related pressure injuries can lead to significant morbidity and mortality for the patient and potential legal and financial risks for healthcare organizations. This learning activity will outline the incidence, complications, and costs of unplanned extubation and medical devicerelated pressure injuries. Best practices and guidelines for endotracheal tube securement and management will also be shared. The characteristics of optimal endotracheal tube securement devices will then be discussed to help RN’s, ICU RN’s, respiratory therapists, advance practice practitioners, and physicians working in any critical care setting to ensure the safety of their intubated patients.