Non-Cochrane · prognostic · PM42051741
Incidence and risk factors of oral mucosal pressure injury in patients with oral tracheal intubation: systematic review and meta-analysis.
Gao Yating, Zhang Li, Zhu Qingjie, et al. · Frontiers in medicine · 2026 · PubMed · doi:10.3389/fmed.2026.1783726
Findings
Population Adults (18 years or older) with oral tracheal intubation and no oral mucosal injury before intubation
29 findings
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Sample size: <500 | Pooled incidence (%) 30 [23, 39] GRADE not reported 17 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: OMPI assessment scale: Others | Pooled incidence (%) 21 [11, 32] GRADE not reported 6 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Evaluation frequency: Not mentioned | Pooled incidence (%) 16 [14, 41] GRADE not reported 11 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Fixed type: Decompression fixation | Pooled incidence (%) 18 [8, 30] GRADE not reported 7 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Country: China | Pooled incidence (%) 28 [23, 34] GRADE not reported 19 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: OMPI assessment scale: NPIAP | Pooled incidence (%) 37 [14, 63] GRADE not reported 7 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Study design: Cohort study | Pooled incidence (%) 31 [24, 38] GRADE not reported 17 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Fixed type: Not mentioned | Pooled incidence (%) 32 [10, 60] GRADE not reported 5 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Country: Other countries | Pooled incidence (%) 35 [4, 76] GRADE not reported 5 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Evaluation frequency: >2 per day | Pooled incidence (%) 36 [28, 44] GRADE not reported 5 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Study design: Case-control | Pooled incidence (%) 26 [9, 48] GRADE not reported 7 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury | Pooled incidence (%) 29 [21, 38] GRADE not reported 24 studies · 9904 participants |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Sample size: >500 | Pooled incidence (%) 27 [12, 46] GRADE not reported 7 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Fixed type: Traditional fixation | Pooled incidence (%) 36 [30, 41] GRADE not reported 12 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: OMPI assessment scale: ROMPIS | Pooled incidence (%) 30 [23, 38] GRADE not reported 11 studies |
| Oral tracheal intubation | None | Incidence of oral mucosal pressure injury Subgroup: Evaluation frequency: <=2 per day | Pooled incidence (%) 30 [17, 46] GRADE not reported 8 studies |
| Higher APACHE II score | Lower APACHE II score | Oral mucosal pressure injury (OMPI) | OR 1.32 [1.19, 1.50] GRADE not reported 8 studies · 2431 participants |
| Longer tracheal intubation indwelling time | Shorter indwelling time | Oral mucosal pressure injury (OMPI) | OR 1.08 [1.05, 1.12] GRADE not reported 15 studies · 4019 participants |
| Higher RASS score | Lower RASS score | Oral mucosal pressure injury (OMPI) | OR 1.34 [0.65, 1.95] GRADE not reported 6 studies · 1606 participants |
| Higher serum albumin (g/L) | Lower serum albumin | Oral mucosal pressure injury (OMPI) | OR 0.37 [0.20, 0.68] GRADE not reported 5 studies · 1158 participants |
| Higher hemoglobin (g/L) | Lower hemoglobin | Oral mucosal pressure injury (OMPI) | OR 0.94 [0.80, 1.01] GRADE not reported 2 studies · 539 participants |
| Use of vasoconstrictive drugs | No vasoconstrictive drugs | Oral mucosal pressure injury (OMPI) | OR 1.55 [1.25, 1.92] GRADE not reported 5 studies · 1110 participants |
| Prone position ventilation | No prone position ventilation | Oral mucosal pressure injury (OMPI) | OR 3.94 [2.64, 5.93] GRADE not reported 3 studies · 1222 participants |
| Hypoproteinemia (<35 g/L) | No hypoproteinemia | Oral mucosal pressure injury (OMPI) | OR 4.9 [1.95, 12.30] GRADE not reported 2 studies · 185 participants |
| Diabetes | No diabetes | Oral mucosal pressure injury (OMPI) | OR 5.31 [1.88, 14.87] GRADE not reported 2 studies · 780 participants |
| Use of hard dental pads | No hard dental pads | Oral mucosal pressure injury (OMPI) | OR 3.22 [2.25, 4.66] GRADE not reported 5 studies · 1381 participants |
| Use of anticoagulant drugs | No anticoagulant drugs | Oral mucosal pressure injury (OMPI) | OR 1.68 [1.02, 2.77] GRADE not reported 4 studies · 498 participants |
| Use of sedative drugs | No sedative drugs | Oral mucosal pressure injury (OMPI) | OR 3.35 [2.16, 5.21] GRADE not reported 3 studies · 906 participants |
| Larger tracheal intubation model (tube size) | Smaller tube model | Oral mucosal pressure injury (OMPI) | OR 2.72 [1.62, 4.62] GRADE not reported 2 studies · 169 participants |
Included primary studies 32
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Chen et al. 2024 matched by author and year (probable) | NR | 1 other review | Incidence of oral mucosal pressure injury | not extracted yet |
| Zhao et al. 2025 matched by author and year (probable) | NR | 1 other review | Incidence of oral mucosal pressure injury | not extracted yet |
| Ai 2025 Association between nutrition risk and oral mucosal membrane pressure injury in critically ill adults requiring endotracheal tube… DOI:10.1002/jpen.70004 | 2025 | this review only | not stated | not extracted yet |
| Ai et al. 2025 Association between nutrition risk and oral mucosal membrane pressure injury in critically ill adults requiring endotracheal tube… PMID:40798878 | 2025 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Cai 2025 Development and validation of a predictive model for oral mucosal pressure injury risk in ICU patients with endotracheal intubation DOI:10.3389/fmed.2025.1695085 | 2025 | this review only | not stated | not extracted yet |
| Cai et al. 2025 Development and validation of a predictive model for oral mucosal pressure injury risk in ICU patients with endotracheal intubation. PMID:41488076 | 2025 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Cambaz 2024 Incidence, characteristics and risk factors of endotracheal tube‐related pressure injuries in intensive care units DOI:10.1111/nicc.13164 | 2024 | this review only | not stated | not extracted yet |
| Cambaz et al. 2024 Incidence, characteristics and risk factors of endotracheal tube-related pressure injuries in intensive care units. PMID:39343762 | 2024 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Chen 2025 Characteristics and Risk Factors of Oral Endotracheal Tube‐Related Mucous Membrane Pressure Injury in Intensive Care Units DOI:10.1111/nicc.70090 | 2025 | this review only | not stated | not extracted yet |
| Chen et al. 2025 Characteristics and Risk Factors of Oral Endotracheal Tube-Related Mucous Membrane Pressure Injury in Intensive Care Units. PMID:40506056 | 2025 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Choi 2020 Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective… DOI:10.1016/j.jtv.2020.06.002 | 2020 | this review only | not stated | not extracted yet |
| Choi et al. 2020 Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective… PMID:32800513 | 2020 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Gu et al. 2024 DOI:10.3870/j.issn.1001-4152.2024.20.064 | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Hampson 2018 Impact of the introduction of an endotracheal tube attachment device on the incidence and severity of oral pressure injuries in the… DOI:10.1186/s12912-018-0274-2 | 2018 | this review only | not stated | not extracted yet |
| Hampson et al. 2018 Impact of the introduction of an endotracheal tube attachment device on the incidence and severity of oral pressure injuries in the… PMID:29449786 | 2018 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| He et al. 2024 DOI:10.20019/j.cnki.1672-0024.2024.02.117.06 | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Hu et al. 2025 Predictive value of Braden scale combined with hemoglobin and hematocrit for oral mucosal pressure injury risk in ICU patients. PMID:40672569 | 2025 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Li 2025 Incidence of, and factors associated with, oral mucous membrane medical device-related pressure injury in critically ill patients with… DOI:10.1136/bmjopen-2024-098114 | 2025 | this review only | not stated | not extracted yet |
| Li et al. 2024 DOI:10.3969/j.issn.1671-9875.2024.06.001 | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Li et al. 2025 Incidence of, and factors associated with, oral mucous membrane medical device-related pressure injury in critically ill patients with… PMID:40527564 | 2025 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Liu et al. 2022 Urinary trypsin inhibitor suppresses excessive superoxide anion radical generation in blood, oxidative stress, early inflammation, and… PMID:20223106 | 2010 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Ozdemir 2025 Risk factors for oral mucosal pressure injury associated with endotracheal tubes in intensive care unit patients: A single‐centre… DOI:10.1111/nicc.70009 | 2025 | this review only | not stated | not extracted yet |
| Ozdemir and Kavakli 2025 Risk factors for oral mucosal pressure injury associated with endotracheal tubes in intensive care unit patients: A single-centre… PMID:40068960 | 2025 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Wang et al. 2024 DOI:10.19749/j.cn.cjgd.1672-2973.2024.04.002 | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Wang et al. 2024 DOI:10.3760/cma.j.cn115682-20230806-00391 | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Wang et al. 2026 DOI:10.3969/j.issn.2096-8213.2026.03.042 | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Wickberg and Falk 2017 The occurrence of pressure damage in the oral cavity caused by endotracheal tubes DOI:10.1177/2057158516656109 | 2016 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Xia 2026 Adrenal glucocorticoid response to exogenous adrenocorticotropin mediated by density and social disruption in lactating cows. PMID:202617 | 1977 | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Yang 2025 matched by author and year (probable) | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Yu and Wu 2023 matched by author and year (probable) | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Zhang et al. 2024 DOI:10.12102/j.issn.1009-6493.2024.20.004 | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
| Zhang et al. 2025 DOI:10.7619/jcmp.20242083 | NR | this review only | Incidence of oral mucosal pressure injury | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults aged 18 years or older undergoing oral tracheal intubation with no oral mucosal injury before intubation | Orally intubated ICU/emergency ICU patients (n=9,904; 2,576 cases, 7,328 controls); 19 Chinese studies |
| Intervention | Risk factors (exposures) for oral mucosal pressure injury | 13 risk factors pooled (from 52 reported) |
| Comparison | Not specified | Not specified |
| Outcomes | Incidence of OMPI; risk factors for OMPI (OR) | Pooled OMPI incidence 29% (24 studies); ORs for 13 risk factors |
| Study designs | Cross-sectional, case-control or cohort studies | 17 cohort and 7 case-control studies |
| Timing | Not specified | Not specified |