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A plea for avoiding systematic intubation in severely hypoxemic patients with COVID-19-associated respiratory failure

By June 15, 2020 No Comments

In early February 2020, Yang et al. reported an alarming high mortality rate in patients with COVID-19-associated acute respiratory failure requiring mechanical ventilatory support. Such a dreadful outcome was regarded as the fundamental tenet dictating our strategy to treat patients with COVID-19 acute respiratory failure. Two essential recommendations were offered to the medical community in keeping with these first reports: early intubation of hypoxemic patients. Indeed, since a profound hypoxemia appears to be the hallmark of COVID-19-associated pneumonia, the initial consensus was to start invasive mechanical ventilation as soon as possible due to the overwhelming number of patients in respiratory failure presenting at the same time in a hospital and to prevent the risk of hypoxic cardiac arrest; avoidance of high-flow nasal cannula (HFNC) to reduce respiratory droplet aerosolization for healthcare workers in what was seen as “inevitable” intubations.

Read the Letter to the Editor in Critical Care here.