The use of nasal high-flow (NHF) during emergency intubation in children did not result in a reduction in hypoxemic events or an increase in the frequency of successful intubation on the first attempt.

However, in the per-protocol analysis, there were fewer hypoxemic events but no difference in successful intubation without hypoxemia on first attempt.

Barriers to the application of NHF during emergency intubation and the reasons for abandoning intubation attempts before physiological compromise should be further investigated to inform future research and recommendations for intubation guidelines and clinical practice.

Between May 9, 2017, and Oct 22, 2022, 1069 intubations in 969 children were randomly assigned to the NHF group (535 intubations) or standard care group (534 intubations).

The primary analysis comprised 950 intubations in 860 children, with 476 intubations in the NHF group and 474 in the standard care group.

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