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.