Discuss with PICU. Consider meningitis after resuscitation.

Indications for tracheal intubation and mechanical ventilation:

• Threatened or actual loss of airway patency (e.g. GCS below 9, response to pain only).
• Need for any form of assisted ventilation e.g. bag–mask ventilation.
• Clinical observation of increased work of breathing
• Hypoventilation or apnoea
• Features of respiratory failure
  • including- irregular respiration (e.g. Cheyne–Stokes breathing)
  • hypoxia (saturation below 94% in air, PaO2 below 13 kPa or 97.5mmHg)
  • hypercapnia (PaCO2 above 6 kPa or 45 mmHg)
• Continuing shock following 40ml/kg of resuscitation fluid
• Signs of raised intracranial pressure
• Impaired mental status
  • GCS drop of 3 or over
  • score below 9
  • fluctuation in conscious level
  • moribund state
• Control of intractable seizures
• Need for Stabilisation for brain imaging or for transfer to PICU.

Should be undertaken by a health professional with expertise in paediatric airway management. Consult PICU.