Preoxygenation and prevention of desaturation during emergency airway management

Ann Emerg Med. 2012 Mar;59(3):165-75.e1. doi: 10.1016/j.annemergmed.2011.10.002. Epub 2011 Nov 3.


Patients requiring emergency airway management are at great risk of hypoxemic hypoxia because of primary lung pathology, high metabolic demands, anemia, insufficient respiratory drive, and inability to protect their airway against aspiration. Tracheal intubation is often required before the complete information needed to assess the risk of periprocedural hypoxia is acquired, such as an arterial blood gas level, hemoglobin value, or even a chest radiograph. This article reviews preoxygenation and peri-intubation oxygenation techniques to minimize the risk of critical hypoxia and introduces a risk-stratification approach to emergency tracheal intubation. Techniques reviewed include positioning, preoxygenation and denitrogenation, positive end expiratory pressure devices, and passive apneic oxygenation.

Publication types

  • Review

MeSH terms

  • Airway Management / adverse effects
  • Airway Management / methods*
  • Emergencies*
  • Humans
  • Hypoxia / prevention & control*
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods
  • Neuromuscular Depolarizing Agents
  • Oxygen Inhalation Therapy* / methods
  • Positive-Pressure Respiration
  • Posture
  • Respiration, Artificial
  • Risk Factors
  • Time Factors


  • Neuromuscular Depolarizing Agents