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.