Indications and timing of endotracheal intubation in intensive care: state of the art

Abstract

Endotracheal intubation and mechanical ventilation are part of usual therapeutic arsenal in intensive care. They are intended to treat respiratory failure and may be considered in the management of neurological or hemodynamic failures. Nevertheless, invasive mechanical ventilation is associated with potentially serious adverse effects. Its indications are not always well codified, the question of its optimal timing is rarely addressed in the recommendations and differences in practice between centers or practitioners play an important role in the decision-making process. Beyond the indication, the choice of the right moment for endotracheal intubation should consider the risk benefit ratio of mechanical ventilation as well as the potential interest of avoiding unnecessary intubation but with the associated risk of late intubation. In this update, we propose a review of the literature on the place and delay of orotracheal intubation in the management of the most common respiratory, hemodynamic, and neurological failures encountered in intensive care medicine.