Based on previous cases of H1N1 infection in noncancer patients, Ramsey et al. [6] described a significant proportion of patients with hypoxemic respiratory failure, specially when associated with comorbidities. Early intubation and admission in the ICU is prudent, given the rapid progression of hypoxemia. Based on current evidence, authors recommend patients should be managed with a low tidal volume open-lung strategy of ventilation, with PEEP titrated based on FiO 2 to achieve adequate SpO 2 and low Pplat [21, 22] .