[mikecsh]

What a bizarre comment. Every patient who goes under general anaesthesia for surgery (life saving or otherwise) is ventilated and usually without issue.

“Laying tubes into the trachea” I presume refers to tracheostomy.

Let’s be realistic here - if you are requiring a tracheostomy and ventilator, or ECMO the you are severely unwell. A blood transfusion, or small risk of infection is the least of your worries at that point.

As with everything in medicine there is a risk:benefit ratio. If you need ECMO you literally cannot oxygenate your own blood even with a ventilator. No ECMO = you die.

[kragen]

I think there are a significant number of general anesthesia patients who don't get intubated, but the big issue is that being intubated for four hours is very different from being intubated for two weeks, which is very likely to kill you. (And, yes, not breathing will also kill you. But intubation was working so badly that hospitals developed proning protocols for covid patients as a less fatal alternative which was less likely to kill them.)

If squirting oxygenated perfluorodecane up your ass for two weeks can keep you alive more often than proning or intubation, that'd be a great improvement. Could save a lot of lives. Buy Dow Chemical stonks.

[aladoc99]

In general it's true that being on a ventilator for two weeks carries a high mortality, but that's largely due to being sick enough to require ventilation for that duration. Presumably without effective oxygenation or airway protection, these people would have died before the two week mark. COVID pneumonia presents a special case. Early on the thinking was that noninvasive ventilation with bipap etc would promote spread of the virus, so the recommendation was to proceed earlier to intubation. In retrospect this did appear to lead to higher mortality, likely related to ventilator associated pneumonia and sedation and paralytic drugs. So we've returned to a more ordinary stance where intubation is a last resort. So, intubation is bad, but for most circumstances, it beats a trip to the morgue.

[freshair]

General anesthesia is fraught with peril. Every time somebody is put under they're dicing with death.

[mikecsh]

Getting in a car is fraught with peril. Every time somebody gets in a vehicle they're dicing with death.

I think it's important to contextualise the risk. The risk of dying from an anaesthetic is about 1 in 100,000. Compare with risk of dying in a car accident in a given year for example.

And again, it comes down to risk:benefit. Anaesthetics are not given out willy-nilly. The reason for the anaesthetic is considered along with the patient's co-morbidities and personal physiological parameter where relevant. Based on this a reasonable estimate of the personalised risks for that patient for that operation can be given for the patient to choose if they wish to proceed or not.

[creshal]

> Let’s be realistic here - if you are requiring a tracheostomy and ventilator, or ECMO the you are severely unwell.

Obviously. So why use these invasive procedures if a less invasive one could do the job with less risk?

> A blood transfusion, or small risk of infection is the least of your worries at that point.

Did you come straight from the 19th century or something? Hospital acquired infections kill hundreds of thousands of people every year. That's hardly a small worry.

> As with everything in medicine there is a risk:benefit ratio.

No shit. That's why there's interest in alternative procedures with less risk for the same benefit.

> If you need ECMO you literally cannot oxygenate your own blood even with a ventilator.

Unless… there's a new method that bypasses the lungs. Did you read the linked article?

[mikecsh]

Angry much? Calm yourself down.

Clearly if anal oxygen proves to be safer and as effective then it will be adopted. No one is disputing that.

My comment was regarding your expletive laden derision of devices which save hundreds of thousands of lives.

And you seem to have missed the point. I did. It say hospital acquired infections are not prevalent or problematic. My point was that every decision in medicine s based on risk and benefit. If you need ECMO you will almost certainly die without it. If you have ECMO there is a compratively small risk of infection that may kill you.

And yes thanks, I did read the article. I’m also a doctor and have spent many months working in ITU, anaesthesia, and operating theatres, and managing acutely unwell COVID-19 patients.

Let us all be glad you’re not making any treatment decisions.

[creshal]

> Clearly if anal oxygen proves to be safer and as effective then it will be adopted. No one is disputing that.

Could've fooled me with how dismissive you were.

> My point was that every decision in medicine s based on risk and benefit.

Then there should be no problem with highlighting the risks so people realise that alternatives are worth it not just as somehow inferior "second standard" as implied by the person I was replying to, but as equal or better solution.

[mikecsh]

To clarify for you (again), my comment was regarding your unfounded derision of existing, proven, lifesaving technologies—I was not dismissing of the technique proposed in the article.

I don't think _"F### ventilators. They damage the patient's lungs, and laying tubes into the trachea requires traumatic surgery and carries significant secondary infection risk"_ is really offering an informed or balanced discussion of the risks and benefits of intubation and ventilation hence my initial reply.

On the contrary, this offers an emotive, highly negative, and uninformed opinion with no balance. We are in a time of a global pandemic with the general public now aware of intubation, ventilation, ECMO, CPAP, BiPAP, and other respiratory interventions. Many people and/or their families are having to face or consider these interventions. Your comment is potentially harmful.

Against to be clear, the medical profession is (spoiler alert) acutely aware of the risks and negatives of ventilation, including extended ventilation, ECMO, surgical and percutaneous traches, and every other intervention that is offered. These risks are discussed with patients and families who often lack the domain expertise, it therefore being part of the role of the doctor to explain to the best of their knowledge what options the patient has before them and likely outcomes of the different options. Ultimately (ideally) the patient makes a decision for themselves based on this information.

You can be sure that the nuanced and balanced discussion is a little more informative than "F### ventilators".

[creshal]

If someone gets their health advice off Hackernews comments I'd say they need a psychiatrist first.

Yes, they're the least bad treatment options we have right now, I can still be hyped about potential improvements.

> You can be sure that the nuanced and balanced discussion is a little more informative than "F### ventilators".

I'd rather hope so. I've had to ask "so what health risks were you supposed to inform me about according to the form you want me to sign?" way too many times.