{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:35:41Z","timestamp":1781224541606,"version":"3.54.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T00:00:00Z","timestamp":1631750400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The data on long-term nasotracheal intubation among mechanically ventilated critically ill children is limited. The purpose of this study was to compare the rate of post-extubation airway obstruction (PEAO) with nasotracheal and orotracheal intubation.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This open-label randomized controlled trial was conducted in PICU of a tertiary care and teaching hospital in North India from January-December 2020 involving intubated children aged 3 months\u221212 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-min, 30 min, 1, 2, 3, 6, 12, 24, 36, and 48-h after extubation) to monitor for PEAO. The primary outcome was the rate of PEAO; and secondary outcomes were 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.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Seventy children were randomized into nasotracheal (<jats:italic>n<\/jats:italic> = 30) and orotracheal (<jats:italic>n<\/jats:italic> = 40) groups. Both the groups were similar in baseline characteristics. The rate of PEAO was similar between nasotracheal and orotracheal groups (10 vs. 20%, <jats:italic>p<\/jats:italic> = 0.14). The maximum mWCS and mWCS at 10-timepoints were similar in two groups. The time taken for intubation was significantly longer (85 vs. 48 s, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) in nasotracheal group, whereas other secondary outcomes were similar in two groups.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The rate of PEAO was not different between nasotracheal and orotracheal groups.<\/jats:p><jats:p><jats:bold>Clinical Trial Registration:<\/jats:bold><jats:ext-link>http:\/\/ctri.nic.in<\/jats:ext-link>, Identifier: CTRI\/2020\/01\/022988.<\/jats:p>","DOI":"10.3389\/fped.2021.713516","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T04:53:34Z","timestamp":1631768014000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Nasotracheal vs. Orotracheal Intubation and Post-extubation Airway Obstruction in Critically Ill Children: An Open-Label Randomized Controlled Trial"],"prefix":"10.3389","volume":"9","author":[{"given":"Vijay","family":"Kumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh Kumar","family":"Angurana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun Kumar","family":"Baranwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthi","family":"Nallasamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,16]]},"reference":[{"key":"B1","volume-title":"Nasotracheal Intubation","author":"Folino","year":"2021"},{"key":"B2","first-page":"348","article-title":"Nasal vs. oral intubation","volume":"69","author":"Holzapfel","year":"2003","journal-title":"Minerva Anestesiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/0883-9441(87)90137-7","article-title":"Benefits of orotracheal and nasotracheal intubation in neonates requiring ventilatory assistance","volume":"77","author":"McMillan","year":"1986","journal-title":"Pediatrics."},{"key":"B4","first-page":"111","article-title":"Jr","volume":"14","author":"Deutschman","year":"1986","journal-title":"Crit Care Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1097\/00003246-199308000-00010","article-title":"Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial","volume":"21","author":"Holzapfel","year":"1993","journal-title":"Crit Care Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"R583","DOI":"10.1186\/cc3805","article-title":"Hospital-acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients","volume":"9","author":"van Zanten","year":"2005","journal-title":"Crit Care."},{"key":"B7","first-page":"100","article-title":"Sinusitis in long-term intubated, intensive care patients: nasal versus oral intubation","volume":"40","author":"Michelson","year":"1991","journal-title":"Anaesthesist."},{"key":"B8","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1001\/archotol.1992.01880090053016","article-title":"Paranasal sinusitis associated with nasotracheal and orotracheal long-term intubation","volume":"118","author":"Michelson","year":"1992","journal-title":"Arch Otolaryngol Head Neck Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1111\/j.1365-2044.1992.tb02177.x","article-title":"Nosocomial sinusitis in ventilated patients. 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