Preoxygenation strategies in emergency airway management

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Ünlü L and Reid C produced the initial draft of the manuscript. Hayes-Bradley C, George J, and Hohenstein C contributed to conceptual discussions and provided critical feedback. Ünlü L revised and finalized the manuscript. All authors reviewed and approved the final version of the manuscript.

Funding

None.

Ethical approval of studies and informed consent

Not applicable.

Acknowledgments

None.

References

[1] Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012; 59(3):165-175.e1. doi:10.1016/j.annemergmed.2011.10.002

[2] Roveri G, Camporesi A, Hofer A, et al. Preoxygenation with and without positive end-expiratory pressure in lung-healthy volunteers: a randomized clinical trial. JAMA Netw Open. 2025; 8(5):e2511569. doi:10.1001/jamanetworkopen.2025.11569

[3] Cressey DM, Berthoud MC, Reilly CS. Effectiveness of continuous positive airway pressure to enhance pre-oxygenation in morbidly obese women. Anaesthesia. 2001; 56(7):680-684. doi:10.1046/j.1365-2044.2001.01374-3.x

[4] Gander S, Frascarolo P, Suter M, et al. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg. 2005; 100(2):580-584. doi:10.1213/01.ANE.0000143339.40385.1B

[5] Herriger A, Frascarolo P, Spahn DR, et al. The effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon duration of non-hypoxic apnoea. Anaesthesia. 2004; 59(3):243-247. doi:10.1111/j.1365-2044.2004.03625.x

[6] Hayes-Bradley C, Lewis A, Burns B, Miller M. Efficacy of nasal cannula oxygen as a preoxygenation adjunct in emergency airway management. Ann Emerg Med. 2016; 68(2):174-180. doi:10.1016/j.annemergmed.2015.11.012

[7] McQuade D, Miller MR, Hayes-Bradley C. Addition of nasal cannula can either impair or enhance preoxygenation with a bag valve mask: a randomized crossover design study comparing oxygen flow rates. Anesth Analg. 2018; 126(4):1214-1218. doi:10.1213/ANE.0000000000002341

[8] Oliveira JESL, Cabrera D, Barrionuevo P, et al. Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Ann Emerg Med. 2017; 70(4):483-494.e11. doi:10.1016/j.annemergmed.2017.05.001

[9] Greater Sydney Area HEMS. Greater Sydney Area HEMS pre-hospital emergency anaesthesia manual (v 4.0). Sydney HEMS; 2024. Accessed July 17, 2025. https://sydneyhems.com/wp-content/uploads/2024/06/phea-manual-v4.pdf

[10] Grauman S, Johansson J, Drevhammar T. Large variations of oxygen delivery in self-inflating resuscitation bags used for preoxygenation: a mechanical simulation. Scand J Trauma Resusc Emerg Med. 2021; 29(1):98. doi:10.1186/s13049-021-00885-3

[11] Gibbs KW, Semler MW, Driver BE, et al. Noninvasive ventilation for preoxygenation during emergency intubation. N Engl J Med. 2024; 390(22):2165-2177. doi:10.1056/NEJMoa2313680

[12] Grant S, Khan F, Keijzers G, Shirran M, Marneros L. Ventilator-assisted preoxygenation: protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator. Emerg Med Australas. 2016; 28(1):67-72. doi:10.1111/1742-6723.12524

[13] Driver BE, Prekker ME, Kornas RL, Cales EK, Reardon RF. Flush rate oxygen for emergency airway preoxygenation. Ann Emerg Med. 2017; 69(1):1-6. doi:10.1016/j.annemergmed.2016.06.018

[14] Hayes-Bradley C, McQuade D, Miller M. Preoxygenation via a non-rebreather mask comparing a standard oxygen flowmeter rate of 15 Lpm to maximally open. Emerg Med Australas. 2017; 29(3):372. doi:10.1111/1742-6723.12784

[15] Pitre T, Liu W, Zeraatkar D, et al. Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials. Lancet Respir Med. 2025; 13(7):585-596. doi:10.1016/S2213-2600(25)00029-3