Unplanned Extubations in Infants Linked to the Orotracheal Route

Clinicians often opt for orotracheal intubation in infants who require intubation because placement is easier, and orotracheal intubation allows for greater accessibility and ease during emergency procedures.

Unfortunately, it may not always be best for the baby. A recent study by U.S. investigators at Columbia University Irving Medical Center, New York Presbyterian Hospital, and Middlebury College suggests that unplanned extubations (UE) are significantly more likely in infants who undergo orotracheal intubation than in those who undergo nasotracheal intubation.

The trial included all tracheal intubation (TI) events that occurred in a level IV NICU between 2022 and 2024. During that time, there were 1,160 TIs and 23 UEs. The UE rate was three times lower in the nasotracheal intubation group than in the orotracheal intubation group, and this finding held true even after adjusting for sex, gestational age, and birth weight.

The researchers also found a spike in UEs within the first 24-48 hours after insertion among infants who received orotracheal tubes, while infants who received nasotracheal tubes demonstrated a more stable trajectory and had fewer adverse incidents during the same time period.

Since infants who experienced UEs remained on mechanical ventilation longer and had longer NICU stays than those who did not, the authors note that there may also be higher costs associated with orotracheal intubation.

The researchers believe these findings call for additional research, in the form of prospective randomized trials, to further investigate how the route of tracheal intubation may affect unplanned extubations in this vulnerable patient population.

The study was published in the Journal of Perinatology. 

Highlighted in RC Buzz April 27, 2026