Clinically, one of the great unresolved questions of treating critically ill COVID patients is how long to push off intubation. Some deny the controversy, but it is real, & it is quandary. A question uniquely difficult, if not impossible, to address with randomized trials.
One of the first things for the critical care community to do is to acknowledge that it is a serious quandary, and to not pretend that our pre-existing orientation to the proper timing of intubation/MV in acute hypoxemic respiratory failure was right.
And I would add, that for such an important question, there has been a surprising paucity of observational studies — or even commentaries, editorials, debates — in CCM journals.
(Or rather, that a clear and consistent approach even existed).
My personal inclination, channeling @msiuba and #Zentensivism (did I spell that right?), is that we should think about how much we can push the non-invasive envelope: i.e. question is how much (i.e. how long) NIV / HFNC is safe & salubrious.
But humility here is critical.
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