What evidence are you using to claim that intubation has a"large risk" of death?

You know when you see words in a SaidIt post in blue, with a line underneath it? It's a link. If you click on it, your browser will follow the link and you will see the evidence. For fucks sake man you know that 🙄

You say "respirators", but the linked article is about ventilators.

Yes, you are correct, that was a mistype. Sorry.

"In a clarification issued on April 24, JAMA said that if the still-hospitalized patients are included, 3.3 percent of the total number who were on ventilators were discharged and 24.5 percent died."

You can't include people still on the ventilators! You don't know if they will die or not! That is a transparently obvious attempt to muddy the waters by taking advantage of people's innumeracy. That's not a clarification, that is JAMA trying to white-wash the horrific mortality rate.

Out of the 1,151 patients in the study who required ventilation:

• for 831 the outcome is unknown (maybe they died, maybe they didn't);
• 282 patients are known to have died (88% of the 320 patients for whom the outcome is known);
• and 38 survived and came off mechanical ventilation.

You can't divide the number of deaths (282) by the total number of patients on ventilators in the study (1,151) because you're missing out on some people who will go on to die. You have to divide by the number of people for whom you know the outcome, otherwise you're undercounting deaths.

"If we leave out all these deaths, and don't count them, then the mortality is just 24.5%" -- JAMA.

In the worst case, all 831 still on ventilators will die, which would give a mortality of (831+282)/1151 or 97%. (That mortality is, I believe, similar to what the Chinese were reporting out of Wuhan in the early days.)

In the best case, everyone lives and nobody dies, yay! In which case the mortality would be 282/1151 or just under 25%.

But what's the likelihood that not one single person in the 831 patients still on ventilators would die? Pretty damn slim. Almost impossible.Those 831 patients would include some of the sickest patients (otherwise they would have already recovered!) so it would take a damn miracle for every single one to survive. If we followed their progress for more time, we would expect somewhere between 0 and 831 to die.

So the true mortality of the 1151 patients who needed mechanical ventilation is unknown, since we don't know how many of those 831 will die rather than coming off the ventilator. But we do know what happened to a smaller cohort of 320 patients: 88% of them died.

There is no reason to think that those 320 patients included only the sickest patients who were more likely to die, and the 831 still on ventilators only the least sick patients who are more likely to live. If we had to guess, knowing nothing about the patients, we'd guess that the two groups were roughly the same, or if anything, the group still on the ventilators were sicker with worse prognosis.

Surely that would be significantly confounded by people dying of covid. One would explect most of those deaths to be due to covid.

Indeed. But we are discussing intubation in the context of Covid patients in ICU.

The place to look would be patients who are intubated for surgery when the surgery isn't life threatening.

How is that relevant?

• With Covid, you have patients who are extremely sick with a respiratory infection serious enough to put them in the ICU, possibly with preexisting lung damage, who will be intubated for days or weeks.
• With non-life-threatening surgery, you have patients who are typically healthy apart from whatever needs the surgery; or at least not sick enough to be in ICU; they don't have lung damage and they will only be intubated for an hour or three.

(Actually it is unlikely they will be intubated at all for minor surgery. Only if the surgery is serious enough that the patient cannot breath with an oxygen mask will they stick a tube into their lungs and hook them up to an external ventilator to breath for them.)

So you're comparing cheese and chalk. What we're interested on is to compare:

• Patients sick enough with Covid to put them in the ICU, who are intubated early (as soon as their Sp02 falls to 70 or less, say);
• Versus equally sick Covid patients in the ICU, who are not intubated early but treated with alternative methods such as non-invasive ventilation, prone positioning, with intubation left only for those for whom those other methods failed to give any improvement.

That's what we really want to know: what's the difference in outcomes for sick Covid patients in ICU between preemptive early intubation, versus alternative treatments.

Really. All of "and many more" are potentially serious?

Yes. Did you bother to follow the links and read the papers I linked to?

From the first:

"Ventilator-associated complications commonly increase morbidity and mortality. They may also prolong the duration of mechanical ventilation as well as the length of stay in the hospital or the intensive care unit (ICU), with increased health care costs."

And from the second:

"... intensive levels of mechanical ventilator support or inappropriate methods of applying mechanical ventilation may be accompanied by a variety of risks, hazards, adverse effects, and complications that may further injure the failing lungs or may add significantly to the morbidity and mortality rates of patients in whom it is applied. (3) Because of the unfavorable risk/benefit ratio of intensive positive pressure mechanical ventilation, physicians should consider the use of alternative methods that are now available for augmenting blood gas exchange in patients in acute respiratory failure who are not adequately treated by safe (mild to moderate) levels of positive pressure mechanical ventilation instead of electing to increase the intensity of positive pressure mechanical ventilation to more dangerous (intensive) levels."

Of all the hills you could pick to die on, "intubation is a minor procedure with negligible risk to the patient" is a very odd one to choose.

It seems to me that you're claiming things, and not caring or even thinking about whether they're accurate.

If I have given you that impression, I am sorry, because I do care. But this is SaidIt, not the British Medical Journal. I have no proof-reader to look for trivial typos or flag when I have used the wrong word. There's no peer review except other Saiditors. Sometimes I make mistakes.