Intubation: Orotracheal vs. Nasotracheal, Indications, Risks, and Procedure

Definition

Intubation is placement of an endotracheal tube (ETT) through the mouth (orotracheal) or nose (nasotracheal) into the trachea to secure the airway and enable mechanical ventilation.

Indications

• Respiratory failure (hypoxemia, hypercapnia)
• Airway protection (decreased GCS, overdose, stroke)
• Surgery (general anesthesia)
• Cardiac arrest

Routes

• Orotracheal – Faster, easier, larger tube; preferred in emergencies.
• Nasotracheal – Better tolerance for awake/long-term; used when mouth access limited.

Risks

• Dental/laryngeal trauma
• Esophageal intubation (unrecognized → fatal)
• Aspiration
• Ventilator-associated pneumonia
• Barotrauma/volutrauma

Confirmation

End-tidal CO₂ (capnography) is the gold standard. Chest X-ray confirms depth.