Discussion
hypoxemic respiratory failure, critically ill, ARDS, ARF
CRITICALLY ILL, ARF, COVID-19 PNEUMONIA, DISEASE, ARDS, HYPOXEMIC RESPIRATORY FAILURE
The main finding of this research piece is that in critically ill patients with COVID-19 pneumonia who did not require intubation at admission to the ICU, intubation within the 24 h after ICU admission was found to be associated with a lower risk of mortality compared to those that were intubated out of the 24h window. Remarkably, we found higher mortality in the late intubation group compared to patients that were intubated within the first 24h even though those patients were younger, presented with less severe disease, and with a higher PaO2/FiOThe cut-off between early and late intubation remains controversial and somewhat arbitrary. Several studies using the cut-off 24-hours after ICU admission found no significant differences in ICU mortality [It might be more logical to establish the cut-off according to the onset of severe hypoxemic respiratory failure, although it will probably be coincidental to the ICU admission moment. Ranieri et al. [When the decision to intubate is related with clear signs of ARF and late intubation is considered, early intubation is related with less mortality risk [We established a 24 h after ICU admission cut-off point due to the characteristics of our database. Our findings were similar to those seen in patients with ARDS [Our study has several strengths. It is a multi-centre study conducted in 73 ICUs and including many critically ill patients. Moreover, data were collected over a 1-year period including different waves of the pandemic, thus avoiding possible biases related to variations in treatment arising from differences in the availability of resources and knowledge about the disease [Our study also has some limitations. The decision to intubate was not protocolized, and the reason for intubation was not recorded. Unfortunately, in order to obtain a large sample size with low missing data, we did not collect additional mechanical ventilation variables (e.g., driving pressure and mechanical power) [