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Most intubations in the critically ill involve pre-oxygenation http://www.selleckchem.com/products/Rapamycin.html followed by rapid sequence induction with application of cricoid force. When supplemental pure oxygen is given to healthy patients for 4?min before anaesthesia, the arterial partial pressure of oxygen (PaO2) typically increases from 90?mmHg to >?400?mmHg. Critically ill patients may be hypoxaemic before pre-oxygenation and this intervention is often largely ineffective. In 42 critically ill patients failing non-invasive respiratory support who underwent tracheal intubation, the baseline mean PaO2 was 67?mmHg and this increased to just 104?mmHg after 4?min of 100% oxygen delivered with assisted ventilation using a bag-mask device [35]: in one third of patients baseline PaO2 was unchanged after pre-oxygenation. So it is not surprising that severe hypoxaemia may occur during intubation in up to a quarter of critically ill patients http://www.selleck.cn/products/AP24534.html [4]. In contrast to the situation in healthy subjects [36], extending the pre-oxygenation period from 4?min to 8?min does not usefully increase PaO2 in the critically ill [37], but use of non-invasive ventilation for pre-oxygenating hypoxaemic patients does reduce the incidence of severe hypoxaemia at the time of intubation [38]. In patients with acute lung injury a recruitment manoeuvre applied directly after intubation reduces the incidence of hypoxaemia [39]. In obese patients, use of a 25�� head-up position during pre-oxygenation increases PaO2 and prolongs the time to desaturation during apnoea [40]. Depending on the precise definition, the incidence of severe hypotension following intubation is 6�C25% [4, 5, 7], and the incidence of cardiac arrest following http://www.selleckchem.com/products/jq1.html intubation is 2�C3% [1, 2, 4]. Use of ketamine or etomidate can reduce the incidence of severe hypotension (compared with thiopental or propofol) [41]. Use of either drug in acutely ill patients limits the incidence of hypotension (systolic blood pressure