As intensivists with experience managing patients with coronavirus disease COVID-19 respiratory failure, we read with interest the article by Wong et al. describing risk factors for successful emergency airway management in COVID-19 patients. We applaud the impressive size, completeness, and multinational breadth of the dataset compiled by the authors.

We recognize that first-pass success is an important metric for airway management and that COVID patients are challenging, in part due to precautions against disease transmission. However, we note that successful intubation may not fully describe the risk involved in difficult airway management, and that even when airway management is ultimately successful, physiologic derangements during the intubation process can be common.

Patients with COVID-19 may be particularly at risk for physiologic deterioration during airway management. In our hospital we found that aggressive use of noninvasive ventilation allowed many patients to avoid intubation. However, those who failed...

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