Oral versus Nasal Intubation

The most recent ATLS guidelines suggest that practitioners providing emergency airway management should proceed with the method of intubation with which they are most proficient.^[40] In general, oral intubation is preferred over nasal intubation in the emergency setting because of the risk of direct brain trauma from nasal instrumentation in a patient with a basal skull or cribriform plate fracture. Furthermore, nasal intubation poses a risk of sinusitis in a patient who will be mechanically ventilated for more than 24 hours; use of a smaller-diameter tube will also increase the difficulty of subsequent airway suctioning and fiberoptic bronchoscopy. If nasal intubation is most likely to be successful in a given situation, however, this route is the one that should be used. Change to an oral tube with a larger internal diameter can occur once the patient's condition has stabilized.