I recently appeared on the RNMD podcast to discuss the topic of intubation timing in patients with (COVID) ARDS. Click here for the link to the episode on Spotify, or find it on your favorite streaming platform.
I’ll be the first to admit there is not a clear right answer here, but there are some signals about what might be harmful.
One of the challenges of zentensivism is deciding when escalation of care outweighs the benefits of minimalism. There is no better example of this than in intubation timing. The risk of lung injury from vigorous spontaneous breathing is a possibility, though it’s unclear if it is more or less harmful than all that comes with invasive ventilation (sedation, potential immobility, loss of communication, etc).
Our knowledge about non-invasive respiratory support continues to grow, especially as we consider alternative interfaces like the helmet for non-invasive positive pressure ventilation.
Hope you enjoy the episode! Depending on your priors, I imagine we will find much to agree or disagree on – though likely a combination of the above.