When would you consider intubation?
Overall assessment at the bedside and clinical judgement are key. No one test has been shown to reliably predict the need for intubation. However, concerning features which are associated with an increased risk of intubation include:
- Inability to effectively clear secretions or other evidence of bulbar dysfunction.
- Worsening Forced Vital Capacity – less than 15ml/kg or a rapid decline from baseline.
- Worsening respiratory failure on arterial blood gas analysis.
Autonomic instability may be exacerbated in the peri-intubation periods. Hypovolaemia is common, and resuscitation to euvolaemia may mitigate against that instability. Bradycardia may require management with atropine.