High flow nasal cannula for preoxygenation in rapid sequence intubation: a narrative review

Preoxygenation is a critical step in rapid sequence intubation (RSI) to reduce hypoxemia risk during airway management. High-flow nasal cannula (HFNC) delivers heated, humidified oxygen at high flow rates, enabling continuous delivery during both preoxygenation and apnea. This review summarizes evidence comparing HFNC with conventional methods, including face masks, bag-valve-mask (BVM) devices, and noninvasive ventilation (NIV) in critical care and emergency settings. Findings across randomized trials and observational studies are mixed: some report reduced desaturation and improved oxygenation with HFNC, while others show no significant benefit in lowest Peripheral oxygen saturation (SpO₂) or hypoxia rates. HFNC is well-tolerated and safe, but its superiority remains unproven. Current evidence supports selective use in high-risk patients, with further large-scale studies needed to clarify its optimal role in RSI.

High-flow nasal cannula (HFNC); Preoxygenation; Rapid sequence intubation (RSI); Emergency airway management; Hypoxia

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