Intubation is usually performed on critically ill patients and the occurrence of major adverse events are common.  The important question remains one that is highly debated.  Let us look at it from the patient perspective.  There are at least 2 kinds of patients as far as attitude towards intubation.  There is the “do not resuscitate” group and the “do whatever is necessary” group.

I think that the “do not resuscitate” group probably believe in humane suicide or assisted suicide and are giving the order not to resuscitate due to the fear of what might follow the resuscitation.  They fear being little more than a vegetable being kept alive by a machine and do not wish to be a burden on the family and on society.

On the other hand, I think that the “do whatever is necessary” group wishes to make sure that they are given every chance possible to live and to make the best of the life that they have.  Their mantra may well be “where there is life, there is hope”.

The Journal of the American Medical Association (JAMA) reports that in a study of 2964 patients over 29 countries that the incidence of a major medical event for those critically ill patients who were intubated was 45.2%.  In other words, 54.8% did not present with a major medical event.  The major medical events that were noted were cardiovascular instability in 42.6%, severe hypoxemia in 9.3%, and cardiac arrest in 3.1%. 

The conditions indicated in this JAMA study are conditions for which there is treatment depending upon the severity of the episode.  This gives hope to those of us who are in the “do whatever it takes” group of people.  I do not know what the “do not resuscitate” group feels about the results.  It probably reassures them that they have made the right decision and for some it may give them pause to rethink their do not resuscitate orders.

Since this was a post intubation study several variables were in play.  One of the variables was that some of the intubations were performed by anesthesiologists and others were performed by resident physicians.   Other variables that were noted were how many attempts were made before a successful intubation was achieved.  Other variables were whether the procedure was performed in the emergency room or in the intensive care unit (ICU).

To a person who fits into the “do whatever is necessary” group these are all variables which seem to work in my favor.  I would probably be in the ICU and a surgeon would probably be performing the operation.  All the equipment would be available at a minute’s notice if any adverse event were to take place. 

To intubate or not to intubate.  My answer is yes please do intubate.  When I was young, I would determine whether a stunt on the motorcycle or the trampoline was something for me to try by the percent chance that I had to complete the stunt.  If the odds were greater than 50%, I was up for the task.  The same philosophy applies here.

I include this discussion in a site that is dedicated to COPD because we are at greater risk of Acute Respiratory Distress Syndrome (ARDS) or of respiratory failure than the population at large.