Intubation in the Critically Ill: When, How, and How Long?

Endotracheal intubation is routinely performed in the critically ill setting but carries a high procedural risk and represents a deep cardiorespiratory physiologic impact. Clinical decision to intubate relies heavily on the indication, patient's trajectory, and clinical judgment, rather than rigid cut-offs. Noninvasive ventilation devices are valid methods to delay or avoid intubation in certain clinical scenarios. Before intubation, physiological optimization and personalizing initial ventilatory settings to high-risk patient phenotypes can improve outcomes. Following resolution of the inciting etiology, daily assessment of extubation readiness is essential. This narrative review answers when, how, and for how long to intubate.