Principio de proporcionalidad terapéutica en la decisión de intubación orotraqueal y ventilación mecánica invasiva en paciente COVID-19 grave

In medicine, when the principle of therapeutic proportionality is applied, the means used and the foreseeable end in each patient are assessed. A distinction is made between proportionate or disproportionate treatments, assessing the benefit and usefulness. Among them, is its application in the severe COVID-19 patient that requires orotracheal intubation and invasive mechanical ventilation. Sometimes this can lead to the ethical dilemma of carrying out this procedure and not finding any benefit, but on the other hand generate suffering, pain, and prolongation of their possible agony. Having the ethical duty in these cases not to abandon, but to accompany through palliative care, always informing the family members about the decision that is made. Analysing this principle of therapeutic proportionality and its application in intensive care units requires a moral conscience on the part of the group that has the responsibility of making the decision and resolving the ethical dilemma that arises. Bearing in mind that patients who require orotracheal intubation should be offered all the measures required in invasive and non-invasive mechanical ventilation to improve hypoxaemia. An analysis and reflection on the principle of therapeutic proportionality and its ethical foundation is presented, as well as a systematic review of the medical literature related to patients with COVID-19 disease in acute respiratory failure. Some scientific and ethical considerations are also established to take into account in the COVID-19 patient. The principle of therapeutic proportionality before the decision of orotracheal intubation must be based on a judgment of proportionality. To ensure that all foreseeable means have been taken into account and used to avoid orotracheal intubation, and that the only useful purpose to benefit the patient will be invasive mechanical ventilation.