Many of us have been working under the paradigm that COVID-19 PNA eventually develops into ARDS in the sickest patients. It appears to me that these patients don’t fit into this paradigm.

Many have normal to high compliance and there are certainly reports of patients not showing any signs of distress. What are you seeing clinically?

One of the big fears with using NIV/HFNC is aerosolization. This is a real risk, but for many we are in full PPE which should make this risk minimal. What are your thoughts on NIV/HFNC as an intermediary step for some patients in terms of staff safety and the patients in front of us?

In my reading of available evidence, patients with COVID-19 PNA who get intubated have a mortality rate of anywhere from 50 – 90%. Many studies reporting in the 80% range. This is not a causation of intubation and mechanical ventilation but an association as most of these reports are observational and retrospective. In other words, maybe the patients were just so sick they were going to have a high mortality anyways.

On the flip side this higher mortality may also be the fact that we are intubating patients early and using the ARDSnet protocol.

What are you currently using to manage patients on the ventilator?

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