Table 2.

The Montpellier-ICU intubation algorithm, adapted from [2]

PRE-INTUBATION
1. Presence of two operators
2. Fluid loading (isotonic saline 500 ml or starch 250 ml) in absence of cardiogenic edema
3. Preparation of long-term sedation
4. Pre-oxygenate for 3 min with NIV in case of acute respiratory failure (FiO2 100 %, pressure support ventilation level between 5 and 15 cmH2O to obtain an expiratory tidal volume between 6 and 8 ml/kg and PEEP of 5 cmH2O)
PER-INTUBATION
5. Rapid sequence induction:
- Etomidate 0.2-0.3 mg/kg or ketamine 1.5-3 mg/kg
- Succinylcholine 1-1.5 mg/kg (in absence of allergy, hyperkalemia, severe acidosis, acute or chronic neuromuscular disease, burn patient for more than 48 h and medullar trauma)
- Rocuronium: 0.6 mg/kg IVD in case of contraindication to succinylcholine or prolonged stay in the ICU or risk factor for neuromyopathy
6. Sellick maneuver
POST-INTUBATION
7. Immediate confirmation of tube placement by capnography
8. Norepinephrine if diastolic blood pressure remains < 35 mmHg
9. Initiate long-term sedation
10. Initial 'protective ventilation': tidal volume 6-8 ml/kg, PEEP < 5 cmH,O and respiratory rate between 10 and 20 cycles/min, FiO2 100 % for a plateau pressure < 30 cmH2O
11. Recruitment maneuver: CPAP 40 cmH2O during 40 s, FiO2 100 % (if no cardiovascular collapse)
12. Maintain intubation cuff pressure from 25-30 cmH2O

NIV: non-invasive ventilation; CPAP: continuous positive airway pressure ; FiO₂: inspired fraction of oxygen