For a patient who is septic or otherwise acidotic and hypovolemic with tachypnea (respiratory compensation for metabolic acidemia) and obtundation, tracheal intubation may be required to protect the airway, prevent respiratory failure or facilitate sedation/immobilization for procedures.  On the other hand, sedation/paralysis and/or loss of negative intrathoracic pressure can lead to hemodynamic collapse due to loss of sympathetic tone and decreased venous return.  Anyone have a strategy for coping with this dilemma?

Related question:  Anyone have a reference discussing/quantitating the decrement in endogenous catecholamine secretion associated with tracheal intubation of a patient who is dependent on sympathetic drive?