In the days after COVID-19 arrived in our region, there were many such stories of patients sent to the floor from the Emergency Department who were intubated shortly after admission.

Many of those patients subsequently endured prolonged and complicated courses on the ventilator.

While we would typically use noninvasive modalities such as high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV) for acute respiratory failure, our quickness to intubate was driven by two factors: early reports that noninvasive modalities posed a high risk of failure and subsequent intubation and fear that HFNC and NIV would aerosolize SARS-CoV-2 and unnecessarily expose the heathcare team.

We would soon find out that our thinking was flawed on both accounts.

When we dug into the evidence for early intubation, we realized that these recommendations were based on a 12-patient series in which 5 patients were trialed on NIV but ultimately intubated and placed on invasive mechanical ventilation (IMV).

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