Response

We appreciate the insightful comments from Bambi et al regarding our retrospective study on non-invasive ventilation (NIV) for patients with acute respiratory distress syndrome (ARDS) due to COVID-19.¹  The outcomes associated with NIV in ARDS—whether from COVID-19 or other causes—are mixed. This variability supports NIV’s use, especially during periods of high patient volume and limited resources, including ventilators and skilled clinicians.

Since the establishment of ARDSNet, which identified lung-protective ventilation as the gold standard for ARDS management, significant advancements in research have taken place. However, lung-protective ventilation has remained the mainstay of ARDS treatment for nearly 25 years.^2,3  Before the pandemic, the European Respiratory Society and the American Thoracic Society could not recommend NIV for ARDS because of its inconsistent outcomes.⁴  Additionally, a guideline from the Indian Journal of Critical Care Medicine advised using NIV only for mild ARDS and avoiding it for patients with...