Tracheal intubation is a frequent and high-risk procedure in the intensive care unit (ICU). Unlike elective intubation in the operating room, ICU intubation is often performed under emergent conditions in physiologically unstable patients, leading to increased technical difficulty and higher complication rates. Among these, hypoxemia is particularly frequent and represents a major determinant of morbidity and mortality. Optimizing preoxygenation is therefore a cornerstone of safe airway management in critically ill patients. The aim of this review is to explore the advantages and limitations of each preoxygenation strategy and to provide clinicians with clear, practical guidance to optimize airway management in the ICU. Preoxygenation aims to increase oxygen reserves in order to prolong the duration of safe apnea. Conventional methods include high-flow oxygen delivery through a tightly fitted face mask, though efficacy depends on minimizing leaks. More advanced strategies include non-invasive ventilation (NIV), which improves both alveolar oxygen fraction and lung volume, and high-flow nasal cannula (HFNC), which additionally allows apneic oxygenation during intubation. Randomized controlled trials, including the recent PREOXY study, demonstrate the superiority of NIV over facemask preoxygenation in reducing peri-intubation desaturation, particularly in hypoxemic patients. HFNC is valuable when NIV is contraindicated, while combined approaches (NIV plus HFNC) may further enhance efficacy. Beyond technique, structured protocols and team organization are crucial to reduce complications. In conclusion, preoxygenation is an essential, patient-specific intervention that mitigates the risks of ICU intubation. Familiarity with available methods enables clinicians to tailor strategies, optimize oxygenation, and improve patient safety during this high-risk procedure.

Introduction: Regional anesthesia for foot surgery commonly relies on a five-injection ankle block, a technique associated with technical complexity and patient discomfort. We developed an ultrasound-guided five-in-two (FIT) ankle block based on an anatomical rationale, to provide complete foot anesthesia with only two punctures. Methods: A dual-injection ankle block technique was defined through an anatomical study, consisting of a mid-calf injection targeting the superficial and deep fibular nerves and a distal transverse injection 5 cm above the medial malleolus targeting the tibial, saphenous, and sural nerves. The technique was assessed in a bicentric prospective observational study of adult patients undergoing outpatient foot surgery, with surgical anesthesia as the primary outcome. Secondary outcomes assessed block performance, perioperative pain intensity, 24-hour rescue analgesic consumption, patient-reported experience, and block-related safety. Results: 80 patients received a FIT ankle block, with successful surgical anesthesia achieved in 77 cases (96%). Median sensory and motor block durations were 554 (420–758) and 600 (444–882) minutes, respectively. Pain was minimal, with median Visual Analogue Scale scores of 0 (0–7) during block placement and 0 (0–4) on arrival in the post-anesthesia care unit. Intravenous rescue analgesia was required in 5% of patients. The median Echelle du Vécu de l’Anesthésie LocoRégionale global score was 88 (80–97), and the complication rate was 0% (95% CI 0 to 3.75%). Conclusions: The anatomically guided FIT ankle block is an effective proximal motor-sparing regional anesthesia technique for outpatient foot surgery, providing reliable anesthesia, excellent analgesia, and well-tolerated perioperative outcomes.