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

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.

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.

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, PaO₂/FiO₂, 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.

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.