When you have ADRS ICU treatement is pretty much the only thing keeping you alive. "Randomized trial" in this context means russian roulette - if you don't get a ventilator you'll die almost certainly.
Evidence [0] (partly based on COVID-19, parly on MERS) also says that NIV has a significantly worse outcome than ventilation. People are already getting NIV in some hospitals because they ran out of tubed ventilators.
