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Tracheal intubation in meningococcal disease and septic shock

Cambridge University Hospitals NHS Trust, Cambridge, UK

Correspondence to:
Robert Ross-Russell, Cambridge University Hospitals NHS Trust, Cambridge, UK; robert.ross-russell@addenbrookes.nhs.uk

The first 150 words of the full text of this article appear below.

In a recently published letter to your journal, Dr Gray and his colleagues criticised the newly published algorithm for the treatment of meningococcal disease and septic shock in children.^{1 2} In particular, they were concerned that the "sole trigger" for intubation was 60 ml/kg of fluid resuscitation. This is not the case. The algorithm indicates that after each bolus of fluid, the child should be assessed for "signs of shock". Further, we are concerned that the authors’ recommendations for timing of intubation may result in fatal delays. In the following, we consider the physiological and practical basis for our concerns.

The pathophysiology of septic shock is characterised both by a loss of effective circulating volume resulting in reduced preload in the heart and by cardiac contractility dysfunction, which further diminishes cardiac output and thus vital organ perfusion. This deficit in oxygenation, often demonstrated by rising lactate levels, stimulates increases in . . . [Full text of this article]