Objective To study the advantages and disadvantages of orotracheal and nasotracheal intubation mechanical ventilation used to treat 1332 elderly patients with type Ⅱrespiratory failure. Methods 697 patients underwent a fiberoptic bronchoscope-guided intubation through the nose while 635 patients were treated with orotracheal intubation. Then, intermittent positive pressure ventilation(IPPV) was given. Dynamic blood gas analysis was observed. Results The therapeutical effect in the two groups was satisfactory after three to seven days of rescue. Good compliance, few complications, and tolerance of long-term treatment were observed in the nasotracheal intubation group, compared with the orotracheal intubation group. Conclusion Nasotracheal intubation is a preferable treatment for elderly COPD patients with type Ⅱrespiratory failure who require a long-term invasive mechanical ventilation treatment while oral intubation is suited to emergency .