The COVID-19 pandemic contributed to an unprecedented increase in patients requiring an intensive care unit (ICU) stay for management of acute respiratory distress syndrome (ARDS) due to viral pneumonia. The pandemic also engendered a marked imbalance between the demand for and the supply of mechanical ventilators, leading to increased reliance on noninvasive ventilation (NIV; eg, continuous positive airway pressure and bilevel positive airway pressure). Typically, NIV is used with caution in patients with ARDS because of the potential risks of delayed intubation and increased mortality and the challenges in achieving adequate ventilation and oxygenation in severely hypoxemic conditions. However, investigators have reported negative associations between NIV use and the need for invasive mechanical ventilation among patients with hypoxemic respiratory failure before and during the pandemic. These findings are not observed consistently, though; other teams have reported associations between NIV use and higher rates of treatment failure and escalation to invasive...

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