Hypoxemia and tachypnea should not be the sole indications for intubation, but rather a complete clinical assessment including work of breathing, mental status and increasing PaCO2 and/or acidosis.

Based on experience in NYC, patients who present early in the disease course with oxygen saturations in the 80’s, but who are otherwise clinically well and relatively asymptomatic, do not require intubation.

There have been suggestions that these patients may benefit from prone positioning and HFNC (see below).

The recommendation early in the COVID pandemic to strongly consider early intubation in all patients with oxygen saturations <90% despite non-invasive oxygenation may not be the best approach.

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