Preoxygenation Strategies to Prevent Desaturation during Pediatric Tracheal Intubation: A Systematic Review of Randomized Controlled Trials

syntheses have primarily focused on adult populations.Reviews such as those by Nimmagadda et al. 3 and Baillard et al. 4 have IntroductIonSecuring the airway through tracheal intubation is a cornerstone of pediatric anesthetic and critical care practice, yet it remains one of the most technically demanding interventions due to the unique vulnerabilities of children.Pediatric patients differ from adults not only in airway anatomy, such as proportionally larger tongues, cephalad laryngeal positioning, and smaller airways, but also in physiology, particularly their limited functional residual capacity and increased basal metabolic rate. 1 These features contribute to a rapid decline in oxygen saturation during apnea, often leaving clinicians with a much narrower margin of safety compared with adults.Consequently, the optimization of oxygen stores through preoxygenation becomes indispensable in prolonging safe apnea duration and preventing critical desaturation during intubation. 2 Although the importance of preox ygenation is well established, the bulk of high-quality evidence and systematic 1-