Optimal preoxygenation strategies for endotracheal intubation (ETI) in LRS require both protocol adaptation and clinical resourcefulness. An individualized approach using the most feasible combination of techniques should be based on fundamental principles, which include maximizing inspired oxygen fraction, ensuring adequate preoxygenation duration, and preserving FRC.

Simple interventions such as flush rate oxygen delivery via standard devices, upright patient positioning, and manual application of positive end-expiratory pressure (PEEP) using bag-mask ventilation (BVM) can approximate the effect of advanced devices.

Clinicians can tailor the approach to each patient in each context, which is essential to optimizing preoxygenation and apneic oxygenation, thereby enhancing peri-intubation safety.

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