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 …