What question did this study set out to answer?

Evaluate the efficacy of high-flow nasal oxygenation compared to face mask ventilation during tracheal intubation in infants.

January 22, 2026

High-Flow Nasal Oxygenation in Infants Undergoing Tracheal Intubation: A Single-center Randomized Controlled Trial

Key Points

Evaluate the efficacy of high-flow nasal oxygenation compared to face mask ventilation during tracheal intubation in infants.
Single-center randomized controlled trial
Inclusion of 132 infants undergoing elective surgery
Two groups: HFNO group and control group with face mask ventilation
HFNO group received specific flow rates for preoxygenation and apneic period
Primary outcome assessed was desaturation incidence.
No significant difference in oxygen saturation < 95% between HFNO and control groups (9.2% vs. 13.3%)
Secondary outcomes showed similar intubation success rates and lowest oxygen saturation
HFNO group had significantly less gastric insufflation (36.7% vs. 70.8%; P < .001).

Abstract

Background: High-flow nasal oxygenation (HFNO) is increasingly used as an alternative for preoxygenation and apneic oxygenation during tracheal intubation. However, its efficacy in infants remains underexplored. We evaluated whether HFNO improves intubation outcomes compared to those with face mask ventilation in infants. Methods: This prospective, single-center randomized controlled trial included 132 infants undergoing elective surgery under tracheal intubation. The infants were divided into HFNO and control groups, with both groups receiving 100% oxygen. The HFNO group received HFNO for preoxygenation (0.5 L/kg/min for 3 min) as well as during the apneic period (2 L/kg/min for 1 min) and laryngoscopy (2L/kg/min). The control group received face mask preoxygenation (6 L/min for 3 min), followed by face mask ventilation during the apneic period (6 L/min for 1 min) and no oxygen delivery during laryngoscopy. The primary outcome was the desaturation incidence (peripheral oxygen saturation < 95% for ≥5 s) from preoxygenation to 1 min after intubation. Various secondary outcomes were also assessed. Results: After exclusions, 125 infants were analyzed (HFNO: n=60; control: n=65). There was no statistically significant between-group difference in the incidence of oxygen saturation < 95% (control vs. HFNO: 9.2% vs. 13.3%; relative risk, 1.44; 95% confidence interval, 0.53–3.92; P =.658). With regard to secondary outcomes, the incidence of oxygen saturation < 90%, first-attempt intubation success rate, lowest oxygen saturation, post-intubation end-tidal CO 2 and O 2 , and atelectasis scores were similar between groups. Gastric insufflation was less frequent in the HFNO group; the difference was statistically significant (36.7% vs. 70.8%; P <.001). Conclusions: In the present study involving the use of HFNO for preoxygenation and apneic oxygenation during tracheal intubation in infants, there was no significant difference in the incidence of desaturation between HFNO and face mask ventilation, although the former was associated with less frequent gastric insufflation.

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