The study identified independent risk factors for oral mucosal pressure injury (OMPI) in ICU patients with orotracheal intubation: duration of intubation, use of dental pads, RASS score, brachycephalic obstructive airway syndrome (BOAS), and platelet count (p < 0.05). [1] The model was built on a cohort of 426 intubated patients admitted from May to December 2024 and missing data were addressed using multiple imputation; variables with P < 0.10 in univariate analysis were entered into multivariate logistic regression. [1] The predictive nomogram achieved high discrimination in the development cohort with an AUC of 0.888 (95% CI: 0.849–0.926). [1] The calibration curve showed good agreement between predicted and observed results, and the Hosmer–Lemeshow test showed no significant disagreement (χ2 = 3.95, P = 0.861). [1] Decision curve analysis demonstrated the clinical benefit of the model at threshold risks of 3–100%. [1] An external validation cohort of 152 patients (January–March 2025) confirmed model performance with an AUC of 0.854, sensitivity of 86.5%, specificity of 73.0%, and overall accuracy of 83.7%. [1] The authors emphasized that this is a single-center study and recommend further multicenter validation to verify the generalizability of the results. [1]