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

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

by Eduardo Villarreal-Fernandez, Ravi Patel, Reshma Golamari, Muhammad Khalid, Ami DeWaters and Philippe Haouzi

Critical Care volume 24, Article number: 337 (2020)

Letter to the editor:

In early February 2020, Yang et al. [1] 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: (1) early intubation of hypoxemic patients [2]. Indeed, since a profound hypoxemia appears to be the hallmark of COVID-19-associated pneumonia, the initial consensus [2] 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; (2) avoidance of high-flow nasal cannula (HFNC) to reduce respiratory droplet aerosolization for healthcare workers [3] in what was seen as “inevitable” intubations.