{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:15:33Z","timestamp":1788434133350,"version":"build-2803163510"},"reference-count":77,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Pers. Med.","JPM"],"abstract":"<jats:p>Tracheal intubation in patients at risk of acute hypoxemic respiratory failure (AHRF) carries a high risk of life-threatening desaturation, and the choice of peri-intubation oxygenation strategy critically influences patient safety. This narrative review synthesizes current evidence on non-invasive oxygenation techniques\u2014high-flow nasal oxygen (HFNO), non-invasive ventilation (NIV), and their combination\u2014across the pre-oxygenation, apneic, and awake-intubation phases of airway management. We examine the physiological mechanisms underlying each modality, appraise landmark randomized trials and meta-analyses (including PREOXI, OPTINIV, and OPTIMASK), and address disease-specific considerations in chronic obstructive pulmonary disease, heart failure, interstitial lung disease, severe obesity, obstructive sleep apnea, and obstetric, pediatric, and trauma populations. The evidence supports a phenotype-driven hierarchy rather than a single dominant technique: NIV\u2014optionally combined with HFNO for apneic oxygenation\u2014is preferred in severely hypoxemic critically ill patients, whereas HFNO alone is adequate for many moderately hypoxemic or non-hypoxemic patients. Progressive hypercapnia limits apneic oxygenation, particularly in chronic CO2 retainers, underscoring the value of continuous CO2 monitoring. Persistent under-implementation of NIV-based pre-oxygenation reveals a gap between evidence and practice. Individualized, physiology-guided oxygenation\u2014aligned with the goals of personalized peri-procedural medicine\u2014offers the greatest potential to reduce peri-intubation morbidity.<\/jats:p>","DOI":"10.3390\/jpm16090455","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:55:56Z","timestamp":1788155756000},"page":"455","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Personalizing Peri-Intubation Oxygenation in Patients at Risk of Acute Hypoxemic Respiratory Failure: A Phenotype-Driven Narrative Review of High-Flow Nasal Oxygen and Non-Invasive Ventilation"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0215-5620","authenticated-orcid":false,"given":"Daniele Salvatore","family":"Patern\u00f2","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-7554","authenticated-orcid":false,"given":"Luigi","family":"La Via","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Moltisanti","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Putaggio","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Maria","family":"Piccolo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia Maria","family":"Noce","sequence":"additional","affiliation":[{"name":"School of Anesthesia and Intensive Care, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Scuto","sequence":"additional","affiliation":[{"name":"School of Anesthesia and Intensive Care, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilberto","family":"Duarte-Medrano","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Medica Sur Clinic & Foundation, Mexico City 11510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Nu\u00f1o-L\u00e1mbarri","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, The National Autonomous University of Mexico (UNAM), Mexico City 11510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia Concetta","family":"Lo Giudice","sequence":"additional","affiliation":[{"name":"School of Anesthesia and Intensive Care, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9331-2788","authenticated-orcid":false,"given":"Massimiliano","family":"Sorbello","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"},{"name":"School of Anesthesia and Intensive Care, \u201cKore\u201d University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1001\/jama.2021.1727","article-title":"Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries","volume":"325","author":"Russotto","year":"2021","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1164\/rccm.202111-2575OC","article-title":"Peri-intubation cardiovascular collapse in patients who are critically ill: Insights from the INTUBE Study","volume":"206","author":"Russotto","year":"2022","journal-title":"Am. 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