Endotracheal intubation Patients with any of the following require endotracheal intubation to prevent aspiration and ensure adequate ventilation: Infrequent, shallow, or stertorous respirations Low oxygen saturation (determined by pulse oximetry or ABG measurements) Impaired airway reflexes Severe unresponsiveness (including most patients with a Glasgow Coma Scale score ≤ 8) If increased ICP is suspected, intubation should be done via rapid-sequence oral intubation (using a paralytic drug) rather than via nasotracheal intubation; nasotracheal intubation in a patient who is breathing spontaneously causes more coughing and gagging, thus increasing ICP, which is already increased because of intracranial abnormalities.