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Nasotracheal Versus Orotracheal Intubation in Critically Ill COVID-19 Patients: A Retrospective Study

Year: 2026

Type: article

Abstract: Background: This study aimed to compare the clinical efficacy of nasotracheal intubation (NTI) versus orotracheal intubation (OTI) in severe COVID-19 pneumonia patients requiring mechanical ventilation. Methods: In this retrospective, propensity score-matched cohort study, we consecutively enrolled 45 critically ill adults with COVID-19 who underwent NTI. These patients were matched 1:1 by age and sex with 45 controls who received OTI. Data on sedative, analgesic, and neuromuscular blocking agent (NMBA) usage, tracheotomy incidence, intubation-related complications, and ICU length of stay were extracted from medical records. Multivariable logistic regression was performed to assess the independent association between intubation route and tracheotomy risk. Results: Patients in the NTI group had significantly lower requirements for continuous infusion of sedatives, analgesics, and NMBAs compared with the OTI group (all P < 0.001). The incidence of tracheotomy was significantly lower in the NTI group (6.7% vs. 26.7%, P = 0.011). Multivariable logistic regression analysis, adjusted for age, sex, BMI, PaO 2 /FiO 2 , and SOFA score confirmed that NTI was independently associated with a reduced risk of tracheotomy (adjusted OR = 0.19, 95% CI: 0.04– 0.78, P = 0.022). The incidence of oral ulcers was lower (P = 0.002). No significant differences were observed in other complications, including ventilator-associated pneumonia. Conclusion: In this retrospective study of patients with severe COVID-19 pneumonia, NTI was associated with reduced sedative, analgesic, and NMBA requirements, a lower risk of tracheotomy, and fewer oral complications, without increasing other major adverse events. Given the observational design, these findings should be considered hypothesis-generating, and prospective randomized trials are needed to confirm causality. Keywords: airway management, nasotracheal intubation, orotracheal intubation, severe COVID-19 pneumonia

Source: International Journal of General Medicine

DOI: 10.2147/ijgm.s588399

Authors: Yan-Ling Zhang, Hai-Ding Zou, Ru-Ping Dai, Ru-Yi Luo

Institutions: Central South University, Second Xiangya Hospital of Central South University, Xiangya Hospital Central South University

Language: English

Topic: Airway Management and Intubation Techniques

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836