The present disclosure relates to a device for holding an endotracheal tube. The device includes a rail having opposite ends and a plurality of grooves at least partially along the length of the rail between the opposite ends. The device also includes a tube holder coupled to and slidable relative to the rail between the opposite ends. The tube holder includes at least one lever arm partially received with the grooves of the rail to allow lateral repositioning of the tube holder relative to the rail, a tie having a slit and a plurality of teeth, a base extending away from a patient relative to the at least one lever arm, and a tab extending laterally from the tube holder with the tab configured to be received within the slit of the tie. The base includes a pawl configured to engage at least one of teeth of the tie.