Acute hypoxemic respiratory failure (AHRF) and its more severe form, acute respiratory distress syndrome (ARDS), imply a decrease in the ability to exchange oxygen and carbon dioxide by the lungs due to different causes (¹). This induces an extra activation of central respiratory drive by a multiplicity of factors (²). In turn, excessive respiratory drive increases diaphragm effort and transpulmonary pressure, potentially causing self-inflicted diaphragm and lung injury (³). In recent years, huge efforts have been made to test noninvasive respiratory support able to attenuate respiratory drive (e.g., high flow nasal cannula and helmet noninvasive ventilation) (⁴), protecting the lungs and the diaphragm while the initial insult (e.g., pneumonia) heals. In fact, when respiratory drive remains within physiological limits, spontaneous breathing is associated with many physiological benefits as compared to controlled mechanical ventilation. Sedation and paralysis can be avoided or limited, secretion clearance and airway mucosal activity are preserved limiting the risk of infections, tidal volume distribution within the lungs is more homogenous, and venous return is maintained favoring hemodynamic stability (⁵). In addition to the unphysiological shortcomings of mechanical ventilation, the intubation procedure itself carries potentially catastrophic consequences for hypoxemic patients