Nasal intubation for trauma patients and increased in-hospital mortality

Ryo Yamamoto, Seitaro Fujishima, Junichi Sasaki

Research output: Contribution to journalArticlepeer-review


Purpose: Data regarding harm from nasal intubation in trauma patients have been conflicting. This study aims to elucidate whether nasal intubation is associated with increased in-hospital mortality compared with oral intubation. Methods: A retrospective cohort study on a nationwide trauma registry of 2004–2019 was conducted. Adult trauma patients who underwent nasal or oral intubation during initial resuscitation were selected. In-hospital mortality and lung complications were compared between nasal and oral intubations. A generalized estimating equation model accounting for within-institution clustering was adopted. Patient demographics, comorbidities, mechanism, injury severity, and vital signs on hospital arrival were adjusted. Subgroup analyses were conducted based on age, Abbreviated Injury Scale [AIS] for the head and face, and vital signs on arrival. Results: Among 29,271 patients eligible for the study, 667 were intubated nasally. In-hospital mortality was higher in nasal intubation compared with oral intubation (OR, 1.28 [95% CI, 1.01–1.64]). There were more noninfectious pulmonary complications in nasal intubation (OR, 1.48 [1.14–1.94]). The harms of nasal intubation were observed only in the elderly (age ≥ 75), patients with severe head injury (AIS in the head ≥ 4), and normotensive patients (systolic blood pressure ≥ 90 mmHg). Conversely, mortality was comparable regardless of the route of intubation in patients with complicated facial injury (AIS in the face ≥ 3). Conclusion: Nasal intubation was associated with increased in-hospital mortality, particularly in older patients and severe head injury, but not severe facial injury. The route of intubation should be judiciously decided during trauma resuscitation.

Original languageEnglish
Pages (from-to)2795-2802
Number of pages8
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number4
Publication statusPublished - 2022 Aug


  • Intubation
  • Naso-tracheal
  • Orotracheal
  • Resuscitation
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine


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