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Airway situation
Septic Shock Intubation
In shock, intubation is a hemodynamic procedure. The airway plan and resuscitation plan must run together.
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Clinical-use limit: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment.
Before intubation
- Start resuscitation, antibiotics/source control pathway, pressors, and hemodynamic monitoring before induction when feasible.
- Name the shock risk in the timeout and assign a BP/pressor watcher.
- Choose induction strategy and dose with local protocol and hypotension risk in mind.
During intubation
- Avoid prolonged apnea and avoid excessive positive pressure.
- Confirm placement and immediately reassess BP, EtCO2, perfusion, and ventilation.
- Have push-dose or infusion pressors ready per local protocol.
After intubation
- Sedation/analgesia must be hemodynamically thoughtful.
- Continue sepsis resuscitation and reassess ventilator effect on preload.
- Document tube depth, shock response, and next reassessment time.
Common pitfalls
- Treating intubation as separate from shock resuscitation.
- Propofol or sedatives that worsen hypotension in high-risk patients without a plan.
- No post-tube blood pressure reassessment.