Criteria for initiation of invasive ventilation in septic shock: An international survey

PurposeThe objective of this study is to record intensivists' beliefs on indications and modalities of ventilatory support in critically ill patients with septic shock.MethodsThe instrument is a 23-items questionnaire, sent to all members of the Systemic Inflammation and Sepsis section of the European Society of Intensive Care Medicine.ResultsA total of 186 intensivists from 30 countries completed the survey. For 95% of respondents, intubation should be performed in patients with neurologic or respiratory failure. There was much less consensus about cardiovascular failure as a reason for initiation of invasive mechanical ventilation. Among the 7 hemodynamic criteria proposed, none achieved strong agreement. Among respiratory criteria, hypoxemia, signs of respiratory distress, and cyanosis were the most strongly associated with the will to intubate. Among neurologic criteria, a Glasgow score lower than 8 was strongly associated with the will to intubate. Strikingly, 51% of respondents believed that invasive mechanical ventilation would worsen patients with septic shock, mainly through hemodynamic deterioration (70.4%).ConclusionsThis survey highlights the general belief that invasive mechanical ventilation may worsen hemodynamic status in patients with septic shock. There was general agreement with the mandatory need to initiate mechanical ventilation in patients with respiratory failure and coma, but with little respect to hemodynamic criteria.