title: Criteria for initiation of invasive ventilation in septic shock: An international survey.
abstract: OBJECTIVE
  The objective of this study is to record intensivists' beliefs on indications and modalities of ventilatory support in critically ill patients with septic shock.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  A 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%).
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Medical and Surgical Intensive Care Unit, Raymond Poincaré Hospital, Garches, France. Electronic address: edemontmollin@gmail.com.
authors.forename: Etienne
authors.initials: E
authors.lastname: de Montmollin
authors.affiliation: Medical and Surgical Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Aboab
authors.affiliation: Intensive Care Department, Mútua Terrassa University Hospital, University of Barcelona, CIBER Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: Medical Intensive Care Unit, Saint Louis Hospital, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Medical and Surgical Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*; D012772:Shock, Septic / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: Invasive mechanical ventilation; Septic shock; Survey