ABSTRACTS CRITICARE – IJCCM2022

**Background:** Data on long-term nasotracheal intubation in mechanically ventilated critically ill children are limited. This study aimed to compare the rate of post-extubation airway obstruction (PEAO) between nasotracheal and orotracheal intubation.

**Methods:** This open-label randomized controlled trial was conducted in the PICU of a tertiary care teaching hospital in North India from January to December 2020. Included were intubated children aged 3 months to 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 minutes, 30 minutes, 1, 2, 3, 6, 12, 24, 36, and 48 hours after extubation) to monitor for PEAO. The primary outcome was the rate of PEAO; secondary outcomes included 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.

**Key Results:** Seventy children were randomized: 30 to nasotracheal and 40 to orotracheal groups. Baseline characteristics were similar. The rate of PEAO was 10% in the nasotracheal group vs 20% in the orotracheal group (p = 0.14). Maximum mWCS and mWCS at all 10 timepoints were similar between groups. Time taken for intubation was significantly longer in the nasotracheal group (85 seconds vs 48 seconds, p < 0.001). Other secondary outcomes showed no significant differences.

**Clinical Implications:** The study suggests that the choice between nasotracheal and orotracheal intubation does not significantly affect the rate of post-extubation airway obstruction in critically ill children. However, nasotracheal intubation takes longer to perform, which may be a practical consideration in emergency settings. The similar rates of other complications indicate that both routes are viable, but the longer intubation time for nasotracheal route should be weighed against potential benefits such as better tube stability. Further larger studies may be needed to confirm these findings.