Mechanical ventilators availability survey in Thai ICUs (ICU-RESOURCE I Study).

OBJECTIVE: Mechanical ventilators (MV) have been progressing rapidly. New ventilator modes and supportive equipments have been developed. However; the MV status in Thai ICUs was not available. The objective of this report was to describe the MV supply and availability in Thai ICUs and review some important characteristics regarding of the availability of MV MATERIAL AND METHOD: The ICU RESOURCE I study (Mechanical ventilator part) database was used in the present study. Hospital types, MV brands and models were recorded. Statistically significant differences between and among groups were defined as p-value < 0.05. RESULTS: A total of 2,098 MVs were included in the present study. Of these, 448 electrically independent MVs (Bird's Mark) were noted (21.35%). The remainder of 1,650 (78.65%) MVs were electrically dependent MVs (eMV). About 90 percent of eMVs were from the following seven eMV brands including Benette, Hamilton, Event, Newport, CareFusion or Bird (volume type), Drager and Servo respectively. About half of them were from the two brands of Bennette and Hamilton. Recent advanced MVs including EvitaXL, Hamilton G5, Servo-I and Epi (NAVA) were more available in academic ICUs than in non-academic ICUs. The adult HFOV could be found only in academic ICUs in this survey CONCLUSION: Bird Mark ventilators were also a high proportion of the MVs in Thai ICUs. Bennette and Hamilton were the most highly available MVin this survey. Advanced MV models were more available in academic ICUs (Thai Clinical Trial Registry: TCTR-201200005).

Pitfalls of mechanical ventilation in Thailand.

Pitfalls in the respiratory care and mechanical ventilation for patients continue to prevail in intensive care unit (ICU) or in some hospital wards in Thailand. There are two reasons that explain this phenomenon. Firstly, there are no professional respiratory therapists in Thailand. Secondly, most caregivers do not possess the adequate knowledge and skills requiredfor respiratory care and for initiating, maintaining and weaning patients off mechanical ventilation. Physicians and nurses have to practice in respiratory care and mechanical ventilation without participating in adequate training during their undergraduate studies and postgraduate training. In reality, physicians pay almost no attention to respiratory care. They leave the respiratory toilet, ventilator changes and monitoring of the patients to nurses who have many other tasks to attend to. To solve this problem will require restructuring of the Thai healthcare system. The Parliament will need to pass a "Respiratory Therapy Profession Act" to certify "respiratory therapists " as a new, registered health profession. The Office of the Civil Service Commission has to take the responsibility for creating the job title and a job description for respiratory therapists. Academic institutes have to provide training courses in respiratory therapy and grant appropriate levels of diplomas or certificates in respiratory therapy. Did actics and clinical skills required for respiratory care have to be sufficiently integrated into the curricula for medical students as well as nursing students. Physicians and nurses need to master their skills and acquired appropriate knowledge in respiratory care and mechanical ventilation until we can assure the necessary number of registered or certified respiratory therapists here in Thailand to help avoid such pitfalls.