DeMasi et al. published a review on the current evidence surrounding peri-intubation and intubation practices. While the actual approach and context to each patient will be different it is good to be aware of the actual evidence base for medical decision-making.
Preoxygenation
NIPPV appears to decrease hypoxemia in all subgroups (including in those not requiring supplemental O2 prior to enrollment)
PREOXI trial
Data for HFNC over NRB is inconclusive
Between Induction and Laryngoscopy
BVM decreased hypoxemia vs. no-ventilation, without a higher risk of aspiration
PreVent trial
During Laryngoscopy and Intubation of the Trachea
Apneic oxygenation may increase the lowest oxygen saturation, but a much smaller benefit than pre-induction PPV
Medications
Induction
Still uncertainty re: differences in patient-centered outcomes for etomidate vs. ketamine
NMB
No rigorous evidence for rocuronium vs. succinylcholine (if no contraindications)
Interventions to Prevent Hypotension
Peri-intubation IVF boluses have not been shown to prevent hypotension, need for pressors, or cardiac arrest
Reasonable to have prophylactic vasopressors running or available, but evidence of potential serious dosing errors for push-dose
References
DeMasi SC, Casey JD, Semler MW. Evidence-based emergency tracheal intubation. Am J Respir Crit Care Med. Published online April 16, 2025.
