Yeah, I started to go there earlier, but stopped myself.
Doctors seem to be doing a better job of informing patients (or families) of those issues before intubating, especially if they have multiple risk factors, and a surprising number of cases have opted not to vent.
But also:
1) There are quite a few really sad stories of patients getting dropped at the ED curb by a spouse as if they'll get checked out and be right back out to go home, only to be immediately intubated and sedated, and ultimately dying without family by their side and no chance to say goodbyes.
They now make a lot of effort to make phone calls or video chats to family before intubating anyone, but it's still rough without anyone being able to be there, and then not being able to speak either. And it just adds to the weight of what the nurses have to deal with, emotionally.
2)There's also the murky topic of straining hospital resources. You obviously don't know ahead of time who the 10-30% of survivors will be and you want to save whoever you can, and hopefully we never get to the point of true rationing. But...
It's hard to be blind to the fact that it's a huge amount of risk, resources, and physical & emotional effort that are seeing relatively little success. I don't have an answer. Hopefully we get better at it.
10-30% survival odds are much better than 0, and the negative consequences of being ventilated depends on the ventilator settings; more time is worse, but it also varies by the ventilator pressure.
Germany is seeing better results by ventilating earlier, FYI.
Some of the folks on vents would have survived anyway. Probably fewer than survive with.
But I don't know, severe permanent lung damage guaranteed, delirium and dementia likely, and the misery of the treatment itself, all for a 1-in-5 chance of surviving (where survival is measured only at 30 days)?
I'm not saying nobody should be allowed to make that choice -- they should -- but I don't know that I would.
Doctors seem to be doing a better job of informing patients (or families) of those issues before intubating, especially if they have multiple risk factors, and a surprising number of cases have opted not to vent.
But also:
1) There are quite a few really sad stories of patients getting dropped at the ED curb by a spouse as if they'll get checked out and be right back out to go home, only to be immediately intubated and sedated, and ultimately dying without family by their side and no chance to say goodbyes.
They now make a lot of effort to make phone calls or video chats to family before intubating anyone, but it's still rough without anyone being able to be there, and then not being able to speak either. And it just adds to the weight of what the nurses have to deal with, emotionally.
2)There's also the murky topic of straining hospital resources. You obviously don't know ahead of time who the 10-30% of survivors will be and you want to save whoever you can, and hopefully we never get to the point of true rationing. But...
It's hard to be blind to the fact that it's a huge amount of risk, resources, and physical & emotional effort that are seeing relatively little success. I don't have an answer. Hopefully we get better at it.