Endotracheal intubation-related oral mucosal membrane pressure injuries: a narrative review of biomechanical insights, biomaterial optimization, and intelligent monitoring

Objectives: This article is a narrative review that synthesizes current evidence on orotracheal intubation-related oral mucosal membrane pressure injuries in intensive care unit (ICU) patients, focusing on mechanisms, risk factors, and prevention strategies. The review is intended to inform clinicians and researchers by integrating insights from intensive care, biomechanics, biomaterials, and oral microbiology. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Embase, and CNKI using the terms "orotracheal intubation", "oral mucosal injury", "device-related pressure injury", "biomechanics", "biomaterials" and "oral microbiome". Studies published between 2000 and 2025, including both clinical and experimental research, were considered without language restrictions. Results: Evidence indicates that vertical pressure, shear force, and friction from endotracheal tubes are key contributors to oral mucosal injury. Reported risk factors include advanced age, prolonged intubation, malnutrition, and inflammation. Preventive strategies have been explored in four domains: biomechanical modeling using finite element analysis, biomaterial optimization such as hydrogel and nanocoatings, regulation of the oral microecosystem through probiotics, and intelligent monitoring systems incorporating artificial intelligence and Internet of Things technologies. Conclusions: Orotracheal intubation-related oral mucosal pressure injuries are multifactorial and preventable. This narrative review integrates biomechanical insights, optimized biomaterials, microbiome regulation, and intelligent monitoring into a multidimensional prevention framework. Such strategies may enhance early identification, reduce complications, and improve clinical outcomes in ICU patients.