Oral Versus Nasal Intubation in Infants and Young Children with Heart Disease: A Systematic Review and Meta-analysis.
Diana L Geisser, Joshua Feder, Chloe Rotman et al.
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In 30 seconds
This systematic review and meta-analysis compared oral with nasal intubation in children with cardiac disease, focusing pooled analyses on patients aged ≤2 years. Fifteen studies were identified, including two randomised trials; 13 contributed to meta-analysis. Compared with nasal intubation, oral intubation was associated with higher pooled odds of severe adverse events (OR 2.82, 95% CI 1.24-6.40), multiple attempts and unplanned extubation, but lower odds of inability to intubate (OR 0.06, 95% CI 0.01-0.46). The authors considered nasal intubation a reasonable option where teams have relevant expertise.
Key findings
- Oral intubation was associated with greater odds of severe adverse events than nasal intubation: OR 2.82 (95%CI 1.24-6.40).
- Oral intubation was associated with greater odds of multiple intubation attempts [1.49 (95% CI:1.06-2.10)] and unplanned extubation [OR 1.63 (95% CI 1.27-2.09)].
- Oral intubation was associated with lower odds of being unable to intubate: OR 0.06 (95% CI 0.01-0.46).
- Oral intubation was associated with 37% greater median time to full oral feeds [OR 1.37 (95%CI 1.15-1.64)].
Why it matters
Intubation route may be associated with differences in airway safety, tube security and feeding outcomes in young children with cardiac disease. These pooled findings can inform discussion of route selection, while the lower odds of inability to intubate with the oral route underscore that outcomes do not uniformly favour nasal intubation.
What to keep in mind
The evidence included varied study designs, with only two randomised trials and four studies judged at low risk of bias. The pooled findings are associations and may be affected by differences between studies.