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

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: , 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.