Does Nasal Cannula Oxygen Improve Preoxygenation?

Daniel J. Pallin, MD, MPH


Adding nasal cannula to nonrebreather mask or bag-valve-mask preoxygenation improved end-tidal oxygen levels.


Preoxygenation is used to fill the lungs with oxygen and wash out nitrogen before emergency endotracheal intubation. Investigators assessed the contribution of supplemental nasal cannula–delivered oxygen to end-tidal oxygen levels in a randomized crossover trial of 60 healthy volunteers who received either bag-valve-mask or nonrebreather mask ventilation in each of four scenarios: with and without nasal cannula oxygen and with and without mask leak. End-tidal oxygen levels were measured after 3 minutes of preoxygenation.


Video laryngoscopy (VL) improves intubation success in patients with predicted difficult airways primarily by ensuring glottic visualization. While VL with acute-angled devices has been compared to direct laryngoscopy, there is little information about the clinical equipoise between different hypercurved blades in this setting.


Comment:These results support the common practice of adding nasal cannula oxygen to bag-valve-mask or nonrebreather preoxygenation in emergency airway management scenarios.


Hayes-Bradley C, et al. Efficacy of nasal cannula oxygen as a preoxygenation adjunct in emergency airway management. Ann Emerg Med 2015 Dec 31; [e-pub]. (


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