It will take time for science to deliver the hard data, but in just a few weeks there has been an evolution in thinking regarding when patients with COVID-19 should be placed on a ventilator.

“When [the COVID-19 outbreak] first started, the conventional wisdom was that you had to intubate hypoxic patients early,” noted Peter Viccellio, MD, FACEP, vice chair of the department of emergency medicine for Stony Brook University.

Viccellio shared his thoughts during an ED-focused briefing sponsored by the Patient-Centered Outcomes Research Institute that was broadcast on April 7. “The patients did terribly on a ventilator, but the presumption was that it was because this is a terrible disease,” he explained.

While there is no consensus on the issue, many physicians from the frontlines in New York now favor performing more noninvasive ventilation. Some are trying to avoid using a ventilator at all, Viccellio observed.

For one thing, this approach facilitates the process of moving the patient into different positions, a technique called proning. This is important because proning can make more lung capacity available, boosting oxygenation.

“This is very easy to do on an awake patient. We think it is possible that we might be able to get a lot more patients through without ever having to intubate them,” Viccellio offered. “But even if that fails, if you intubate them five days from now instead of two days from now, you have saved some ventilator time in the face of potential ventilator shortages.”

Less aggressive measures, such as giving patients oxygen, may be needed. However, physicians are finding that such measures, when combined with proning, are proving to be enough to sustain many patients through their course of illness, according to Viccellio.