1. Patients treated with Continuous Positive Airway Pressure or Non Invasive Ventilation, presenting with clinical signs of excessive inspiratory efforts, intubation should be prioritized to avoid excessive intrathoracic negative pressures and self-inflicted lung injury(4). 2. High PEEP in a poorly recruitable lung tends to result in severe hemodynamic impairment and fluid retention; 3. Prone positioning of patients with relatively high compliance results in a modest benefit at the price of a high demand for stressed human resources. After considering that, all we can do ventilating these patients is “buying time” with minimum additional damage: the lowest possible PEEP and gentle ventilation. We need to be patient.