This prospective randomized controlled trial aims to compare the effectiveness of High-Flow Nasal Cannula (HFNC) versus Tight Face Mask (TFM) in maintaining oxygenation during rapid sequence induction (RSI) for endotracheal intubation in adult patients. Participants will be randomly assigned in a 1:1 ratio to receive either HFNC or TFM for preoxygenation before induction of anesthesia. The primary outcome is the lowest peripheral oxygen saturation (SpO₂) recorded from induction until successful endotracheal intubation. Secondary outcomes include the incidence of oxygen desaturation (\<90%), duration of apnea, duration of laryngoscopy, intubation time, number of intubation attempts, and peri-intubation complications. The study will determine whether HFNC provides superior oxygenation compared with conventional face mask preoxygenation during RSI and may contribute to improving airway management protocols and patient safety.
Adults aged 18 years or older.
Patients requiring rapid sequence induction (RSI) for endotracheal intubation in the operating room, emergency department, or intensive care unit.
Patients in whom both high-flow nasal cannula (HFNC) and tight face mask preoxygenation are technically feasible.
Patients (or their legally authorized representatives, when applicable) able to provide written informed consent.
Patients requiring immediate crash intubation without sufficient time for preoxygenation.
Patients with facial deformities, upper airway obstruction, or other conditions preventing the use of either HFNC or a tight face mask.
Known contraindications or hypersensitivity to medications used for rapid sequence induction.
Pregnant women.
Parallel
High-Flow Nasal Cannula
DeviceParticipants assigned to this intervention will receive preoxygenation using a heated, humidified high-flow nasal cannula delivering oxygen at a flow rate of 60 L/min with an inspired oxygen fraction (FiO₂) of 1.0 (100%) for 3 minutes before rapid sequence induction. Oxygen delivery will be continued throughout the apneic period and laryngoscopy until successful endotracheal intubation.
Tight Face Mask
DeviceParticipants assigned to this intervention will receive standard preoxygenation using a tightly fitting anesthesia face mask delivering 100% oxygen at a flow rate of 15 L/min for 3 minutes before rapid sequence induction. The face mask will be removed immediately before laryngoscopy in accordance with standard clinical practice.
Lowest Peripheral Oxygen Saturation (SpO₂) During Rapid Sequence Induction
Incidence of Oxygen Desaturation
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