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

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