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Indication for tracheal intubation in meningococcal disease and septic shock
  1. Martin Peter Gray,
  2. Anami Gour,
  3. Caroline Davison,
  4. Jonathan Round,
  5. Linda Murdoch
  1. St George’s Hospital, London, UK
  1. Martin Peter Gray, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK; martingray2{at}

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We read with interest the recently published update to an algorithm for the early recognition and treatment of meningococcal disease in children.1 Of note there is a change to the recommended trigger point for tracheal intubation. The previously recommended trigger point has moved from after 40 ml/kg of fluid resuscitation in the face of persistent shock to after 60 ml/kg of fluid resuscitation. This is following consideration of the work of Carcillo et al who recommend that up to 200 ml/kg (average …

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  • Competing interests: None.