Nasal Endotracheal Intubation vs. Oral Endotracheal Intubation

In emergency care, anesthesia, intensive care, and other situations requiring respiratory support, nasopharyngeal and oral endotracheal intubation are commonly used techniques to ensure a clear airway. Both methods assist or control breathing effectively. But what sets them apart? Understanding their differences can help in selecting the right approach. Take a few minutes to explore this article for more useful information.  

 
What Is Endotracheal Intubation?

Endotracheal intubation is primarily used to ensure airway patency and provide effective mechanical ventilation support. Depending on the route, it can be divided into nasal endotracheal intubation and oral endotracheal intubation (commonly referred to as oral intubation). Situations where endotracheal intubation is used include:

• Emergency scenarios: When patients experience cardiac arrest, respiratory failure, severe trauma, or other conditions requiring rapid artificial airway establishment.

• General anesthesia: To maintain respiratory function during surgery.

• Intensive care: For conditions like acute respiratory distress syndrome (ARDS) that require prolonged mechanical ventilation.

• Postoperative care: To facilitate suctioning in patients with certain diseases or after specific surgeries.

Key Differences Between Nasal and Oral Intubation

Definition and Procedure

Nasal Endotracheal Intubation

As the name suggests, the tube is inserted through the nose into the trachea, utilizing the nasal airway as a natural conduit. This passage offers a relatively stable artificial airway, making it a reliable choice. However, this technique requires higher technical expertise and is often preferred in situations involving difficult airways or when awake intubation is necessary. 

Oral Endotracheal Intubation

Also known as oral intubation, the tube is inserted through the mouth into the trachea. This is the most commonly used method in clinical practice, especially in emergency situations. Compared to nasal intubation, oral intubation is relatively straightforward and suitable for rapid airway management. 

Advantages and Disadvantages

Nasal Endotracheal Intubation

Advantages:

• Stability: The nasal anatomy helps secure the tube, reducing the risk of accidental displacement.

• Patient comfort: Awake patients tolerate nasal intubation better, particularly for long-term intubation.

• Minimized interference: Ideal for oral or maxillofacial surgeries as it avoids the surgical site.

• Easier post-operative care: Facilitates oral hygiene and nursing care.
  
  

Disadvantages:

• Complexity: Requires higher technical skill and takes longer to perform.

• Nasal complications: Risk of nosebleeds, mucosal injury, sinusitis, or even middle ear infections.

• Increased airway resistance: Narrower tubes may reduce airflow efficiency.

• Limitations: Not suitable for patients with nasal abnormalities or bleeding tendencies.
  
  

Oral Endotracheal Intubation

Advantages:

• Ease of use: Ideal for emergencies requiring quick airway establishment.

• Effective ventilation: Wider tubes improve secretion drainage and airflow.

• Avoids nasal complications: Eliminates risks like nasal trauma or sinus infections. 
  
  

Disadvantages:

• Less stable: Tubes are more prone to displacement due to coughing or suctioning.

• Lower patient tolerance: Awake patients find it uncomfortable, often requiring sedation.

• Oral hygiene challenges: Intubation limits oral cleaning and increases the risk of infections.

• Mucosal injury risk: Long-term use may cause mouth sores or pressure ulcers.
  
   

Application

• Nasal intubation: Frequently used for oral and maxillofacial surgeries due to its comfort and stability.

• Oral intubation: Common in emergency settings, urgent surgeries, or short-term artificial airway needs.
   
  
  

Choosing the Right Tube Size and Depth

Tube size and insertion depth depend on factors like age and gender. Below are general guidelines:

Tube Size

• Adults (Male): Oral tube size (inner diameter) typically 8.0–8.5 mm; nasal tube size 7.0–7.5 mm.

• Adults (Female): Oral tube size 7.5–8.0 mm; nasal tube size 6.5–7.0 mm.

• Children: Use the formula ID = (Age/4) + 4.5 to estimate tube diameter. For children under 5, uncuffed tubes are generally recommended.
  
  

Insertion Depth

• Adults (Male): Oral intubation ~22 cm; nasal intubation ~25 cm.

• Adults (Female): Oral intubation ~21 cm; nasal intubation ~24 cm.

• Children: Estimate depth using the formula Depth (cm) = (Age/2) + 12.

Depth should be adjusted to ensure proper tube placement without being too shallow or too deep. 

Factors Influencing Choice

Surgical Requirements

Nasal intubation is preferred for oral and maxillofacial surgeries to avoid interference with the surgical site. Conversely, oral intubation is the go-to for nasal or sinus surgeries.
 

Patient Condition

Nasal intubation offers higher comfort, making it ideal for awake intubation. Oral intubation is simpler and faster, making it the first choice in emergencies.
 

Conclusion

Both nasal and oral intubation have unique advantages and limitations. By understanding their differences, healthcare providers can choose the most appropriate method based on the patient's condition and surgical needs. Bever Medical offers OEM endotracheal intubation products to help medical professionals ensure optimal respiratory care for patients.