What is the priority intervention in a severe case of ARDS?

• A. Maintain intubation and mechanical ventilation
• B. Immediate tracheostomy
• C. Noninvasive ventilation only
• D. Oxygen by nasal cannula only

Answer: (A)

Securing the airway and providing controlled ventilation is the priority in severe ARDS. With critically impaired oxygenation and high work of breathing, noninvasive methods are often insufficient and can fail, risking rapid deterioration. Endotracheal intubation followed by mechanical ventilation allows precise control of FiO2 and CO2 removal and enables lung-protective strategies (low tidal volumes, appropriate PEEP) to minimize further lung injury while supporting gas exchange. It also provides airway protection against aspiration and allows necessary sedation or neuromuscular blockade and adjuncts like prone positioning. Noninvasive ventilation or oxygen via a nasal cannula cannot meet the demands of severe ARDS, and tracheostomy is not the immediate intervention during the acute phase.