Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation

Preoxygenation is a critical step in airway management aimed at reducing the risk of hypoxemia, a potentially life-threatening complication, during emergency tracheal intubation in critically ill patients. Challenges with ventilation and intubation are unpredictable, making it essential to optimize oxygenation prior to induction to improve patient safety. During the preoxygenation phase of intubation, a patient receives 100% fraction of inspired oxygen (FiO2) to replace alveolar nitrogen, increasing oxygen reserves, and arterial oxygen partial pressure (PaO2) to prolong safe apnea time. Preoxygenation strategies primarily rely on two categories of oxygen delivery systems: noninvasive ventilation (NIV) and oxygen masks. Each has unique advantages and limitations, and both have been studied in various clinical trials. When used effectively, these techniques optimize oxygenation, enhance first-pass intubation success, and reduce peri-intubation complications. This article reviews the physiological basis and technical application of oxygen masks and NIV-based preoxygenation strategies, discusses their comparative efficacy, and provides practical guidance on selecting and implementing the optimal approach based on patient condition and resource availability. By integrating best practices, clinicians can reduce complications and improve outcomes during emergency airway management in critically ill patients.