Nasotracheal vs. Orotracheal Intubation and Post-extubation Airway Obstruction in Critically Ill Children: An Open-Label Randomized Controlled Trial

Abstract

Background: The data on long-term nasotracheal intubation among mechanically ventilated critically ill children is limited. The purpose of this study was to compare the rate of post-extubation airway obstruction (PEAO) with nasotracheal and orotracheal intubation.Methods: This open-label randomized controlled trial was conducted in PICU of a tertiary care and teaching hospital in North India from January-December 2020 involving intubated children aged 3 months−12 years. After written informed consent, children were randomized into nasotracheal and orotracheal intubation groups. Post-extubation, modified Westley's croup score (mWCS) was used at 10-timepoints (0-min, 30 min, 1, 2, 3, 6, 12, 24, 36, and 48-h after extubation) to monitor for PEAO. The primary outcome was the rate of PEAO; and secondary outcomes were time taken for intubation, number of intubation attempts, complications during intubation, unplanned extubation, repeated intubations, tube malposition/displacement, endotracheal tube blockade, ventilator associated pneumonia, skin trauma, extubation failure/re-intubation, duration of PICU stay, and mortality.Results: Seventy children were randomized into nasotracheal (n = 30) and orotracheal (n = 40) groups. Both the groups were similar in baseline characteristics. The rate of PEAO was similar between nasotracheal and orotracheal groups (10 vs. 20%, p = 0.14). The maximum mWCS and mWCS at 10-timepoints were similar in two groups. The time taken for intubation was significantly longer (85 vs. 48 s, p < 0.001) in nasotracheal group, whereas other secondary outcomes were similar in two groups.Conclusion: The rate of PEAO was not different between nasotracheal and orotracheal groups.Clinical Trial Registration:http://ctri.nic.in, Identifier: CTRI/2020/01/022988.

A Comparison between Baska Mask and Endotracheal Tube in Patients Undergoing Gynecological Laparoscopic Surgery

“…However, it was worth noting that anesthesia time, insufflation time, and removal time showed similar results across the studied groups. In consistency with the current study Ahn et al (6) revealed that in comparison with the ETT group, the median insertion time was lower in the Baska group (21.0 s, P=0.000) than in the latter (27.0 [24][25][26][27][28][29][30][31][32][33] s. Also, Maged et al (30) reported that the device insertion time was greatly reduced by the Baska group (28.4±10.7 vs 46.6±19.8, P=0.001).…”

“…Also, Abdel-Ghaffar et al (8) revealed that the median leak pressure in the BASKA group was 32.0 (29-35) cmH 2 O at the time of insertion. This value was reduced during pneumoperitoneum expansion (31.0 [27][28][29][30][31][32][33] cmH 2 O, P=0.000), and thereafter remained constant at this level (30.0 [27][28][29][30][31][32] cmH2O, P=0.000). Furthermore, Choi et al (28) revealed that throughout the procedure, the Baska mask maintained a steady oropharyngeal leak pressure of ≥ 33 cmH 2 O.…”

The Impact of Nasal Intubation on Feeding Outcomes in Neonates Requiring Cardiac Surgery: A Randomized Control Trial

“…A large database study of nasal intubation practices among pediatric cardiac surgery programs revealed that there is not an increased risk of infectious complications in neonates and infants, although older children and adolescents have the same risk pro le as adults (4). Our data supports the growing body of literature showing safety of nasal intubation in this population: our nasally intubated neonates did not experience mediastinitis, ventilator-associated pneumonia, or bacteremia (15). Pressure ulcer formation is a serious concern with nasal endotracheal tubes and should be monitored for diligently, though was infrequent in our sample (16).…”

Clinician opinions on nasal versus oral intubation in infants with BPD: A multicenter survey

“…Of note, two small randomized trials comparing nasal versus oral intubation in infants and young children exposed to brief courses of mechanical ventilation did not find a significant difference in skin injury between ETT locations. 5,6 The placement and management of nasal ETTs may also…”