title: Is nasotracheal intubation safe in facial trauma patients?
abstract: BACKGROUND
  In the prehospital setting, oral intubation is preferred in facial trauma patients due to the potential for further injury during nasotracheal intubation. This study compared the complications of nasal vs. oral vs. nasal + oral intubations performed by first responder crews in facial trauma patients. Our objective was to assess patient outcomes and complications to determine the risk of nasal intubation in facial trauma patients in the prehospital setting.
  
  
  METHODS
  Patients with facial trauma between 2008 and 13 were abstracted from the Miami Valley Hospital trauma registry: 50 were nasal only (n), 27 nasal + oral (no), and 135 oral only (o) intubation. Analysis of variance with the post-hoc Least Significance Difference Test and the chi square test were used in the analysis.
  
  
  RESULTS
  The oral group was older [41.1 ± 17.6 (o) vs. 36.2 ± 14.1 (n) vs. 33.0 ± 15.7 (no), p = 0.032] and had a higher facial abbreviated injury severity (AIS) mean score (1.8 ± 0.6 vs. 1.3 ± 0.5 vs. 1.5 ± 0.5, p < 0.001). The three groups did not differ in mortality (n = 20% vs. o = 18% vs. no = 30%, p = 0.37). The n + o group was intubated longer (p < 0.001) and had longer ICU and hospital lengths of stay (p = 0.015 and p = 0.023). The three groups did not differ on the composite of any pulmonary complication - i.e., any one of sinusitis, pneumonia, atelectasis, and respiratory failure - 44% (no) vs. 24% (o) vs. 30% (n), p = 0.10). However, nasal + oral patients were more likely to have one or more of the eight complication studied [63% (no) vs. 28% (o) vs. 34% (n), p = 0.002], and have a longer ICU and HLOS.
  
  
  CONCLUSIONS
  Prehospital nasal intubation is a viable short-term alternative to oral intubation in patients with facial trauma and warrants further research.
authors.affiliation: Wright State University, Boonshoft School of Medicine, Department of Surgery, 3640 Colonel Glenn Highway, Dayton, OH 45435, United States. Electronic address: jazayeri-moghaddas.2@wright.edu.
authors.forename: Omeed Payam
authors.initials: OP
authors.lastname: Jazayeri-Moghaddas
authors.affiliation: Wright State University, Boonshoft School of Medicine, Department of Surgery, 3640 Colonel Glenn Highway, Dayton, OH 45435, United States. Electronic address: tse.3@wright.edu.
authors.forename: Wayne
authors.initials: W
authors.lastname: Tse
authors.affiliation: Wright State University, Boonshoft School of Medicine, Department of Surgery, 3640 Colonel Glenn Highway, Dayton, OH 45435, United States. Electronic address: herzing.2@wright.edu.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Herzing
authors.affiliation: Wright State University, Boonshoft School of Medicine, Department of Surgery, 3640 Colonel Glenn Highway, Dayton, OH 45435, United States. Electronic address: ronald.markert@wright.edu.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Markert
authors.affiliation: Wright State University, Boonshoft School of Medicine, Department of Surgery, 3640 Colonel Glenn Highway, Dayton, OH 45435, United States. Electronic address: ajgans@premierhealth.com.
authors.forename: Alyssa J
authors.initials: AJ
authors.lastname: Gans
authors.affiliation: Wright State University, Boonshoft School of Medicine, Department of Surgery, 3640 Colonel Glenn Highway, Dayton, OH 45435, United States. Electronic address: mary.mccarthy@wright.edu.
authors.forename: Mary C
authors.initials: MC
authors.lastname: McCarthy
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D004632:Emergency Medical Services; D005151:Facial Injuries / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009820:Ohio / Q000453:epidemiology; D011014:Pneumonia / Q000209:etiology; D012042:Registries; D012852:Sinusitis / Q000209:etiology
keywords: Facial trauma; First responders; Nasal intubation