Editorial
Yes to mechanical ventilation, but not just any
Ventilación mecánica sí, pero no de cualquier forma
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Gordo, J. González del Castillo" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Gordo" "email" => array:1 [ 0 => "fgordo5@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." 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However, such increased need should not result in inadequate application of these techniques<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a>; indeed, their use in the emergency care setting is not uniform, due to the heterogeneity of emergency care physician preparation in the use of such techniques, which require adequate learning and training.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this number of the journal, Jacob et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> present the results of a descriptive study comprising a structured questionnaire, with the aim of analyzing the use of NIMV in the Emergency Care Departments of public hospitals in Catalonia. Their results show that 96% of the Departments use NIMV, which in 78% of the cases is started by emergency care physicians–with an incidence of 43% of the cases in which admission lasts over 24<span class="elsevierStyleHsp" style=""></span>h. The authors indicate that only 39% of the Departments have a protocol of their own, while 35% use a protocol that has been established by consensus with other Departments–this being more common in district hospitals, with consensus generally being established with the Department of Intensive Care Medicine. On the other hand, 25% of the Departments were seen to lack a protocol for the use of NIMV.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In our opinion, this study offers the great advantage of providing a real-life view of the situation, beyond the clinical trial setting, which sometimes does not reflect routine clinical practice. A particularly interesting finding of this study is the description of important shortcomings in training in this field, with no important presence of protocolized training in NIMV. This is particularly relevant, since NIMV is encompassed within the knowledge, skills and techniques required by professionals working in emergency care, contemplated in the training programs of the Spanish Society of Urgencies and Emergency Care Medicine (<span class="elsevierStyleItalic">Sociedad Española de Medicina de Urgencias y Emergencias</span> [SEMES]).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> The authors suggest strategies for improvement that include collaboration among Departments and adequate training of the professionals in charge of the care of these patients.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We feel that the application of MV should be optimized from the out-hospital emergency scenario to the Departments of Intensive Care Medicine. This technique must be correctly applied in all settings in order to obtain the best outcomes, and in this regard we consider it essential to ensure collaboration to ensure adequate training of the different professionals involved (not only physicians but also nursing staff), the development of common protocols, and inter-professional communication systems allowing definition of the best strategy for each individual indication and patient.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> Such efforts would serve to identify individuals at high risk of NIMV failure<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> in which invasive ventilation may be implemented from the start; ensure adequate monitoring; and favor decision making and the analysis of the outcomes on a joint basis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We all must ponder this issue, since segmented or parceled care in which the patient is not really central to the process and is unable to benefit from coordinated and sufficiently qualified professional activity cannot be regarded as acceptable. The truly important issue is not whether to ventilate the patient or not, but to ensure that ventilation is provided adequately and safely.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We consider the relationship between the Departments of Intensive Care Medicine and Emergency Care to be very important, particularly in district hospitals such as those addressed by this study. This model of relationship undoubtedly offers great benefits for patients and allows rational and effective use of the available resources.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">10,11</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gordo F, González del Castillo J. Ventilación mecánica sí, pero no de cualquier forma. Med Intensiva. 2018;42:139–140.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications and resource utilization associated with mechanical ventilation in a Medical Intensive Care Unit in 2013" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Selvan" 1 => "H. Edriss" 2 => "M. Sigler" 3 => "K.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 6 | 11 |
| 2024 October | 51 | 45 | 96 |
| 2024 September | 47 | 20 | 67 |
| 2024 August | 51 | 32 | 83 |
| 2024 July | 54 | 28 | 82 |
| 2024 June | 39 | 45 | 84 |
| 2024 May | 49 | 21 | 70 |
| 2024 April | 67 | 39 | 106 |
| 2024 March | 46 | 26 | 72 |
| 2024 February | 51 | 66 | 117 |
| 2024 January | 35 | 34 | 69 |
| 2023 December | 34 | 31 | 65 |
| 2023 November | 34 | 27 | 61 |
| 2023 October | 31 | 18 | 49 |
| 2023 September | 32 | 32 | 64 |
| 2023 August | 22 | 19 | 41 |
| 2023 July | 30 | 27 | 57 |
| 2023 June | 48 | 19 | 67 |
| 2023 May | 39 | 29 | 68 |
| 2023 April | 30 | 15 | 45 |
| 2023 March | 68 | 34 | 102 |
| 2023 February | 49 | 28 | 77 |
| 2023 January | 39 | 16 | 55 |
| 2022 December | 48 | 32 | 80 |
| 2022 November | 94 | 33 | 127 |
| 2022 October | 59 | 36 | 95 |
| 2022 September | 93 | 28 | 121 |
| 2022 August | 77 | 40 | 117 |
| 2022 July | 26 | 30 | 56 |
| 2022 June | 90 | 27 | 117 |
| 2022 May | 74 | 24 | 98 |
| 2022 April | 92 | 40 | 132 |
| 2022 March | 61 | 50 | 111 |
| 2022 February | 48 | 33 | 81 |
| 2022 January | 69 | 29 | 98 |
| 2021 December | 63 | 48 | 111 |
| 2021 November | 50 | 34 | 84 |
| 2021 October | 58 | 79 | 137 |
| 2021 September | 43 | 40 | 83 |
| 2021 August | 40 | 43 | 83 |
| 2021 July | 33 | 28 | 61 |
| 2021 June | 24 | 26 | 50 |
| 2021 May | 40 | 48 | 88 |
| 2021 April | 94 | 137 | 231 |
| 2021 March | 62 | 23 | 85 |
| 2021 February | 42 | 30 | 72 |
| 2021 January | 55 | 18 | 73 |
| 2020 December | 49 | 11 | 60 |
| 2020 November | 21 | 13 | 34 |
| 2020 October | 52 | 23 | 75 |
| 2020 September | 59 | 24 | 83 |
| 2020 August | 20 | 19 | 39 |
| 2020 July | 51 | 14 | 65 |
| 2020 June | 33 | 19 | 52 |
| 2020 May | 24 | 12 | 36 |
| 2020 April | 42 | 10 | 52 |
| 2020 March | 13 | 13 | 26 |
| 2020 February | 37 | 30 | 67 |
| 2020 January | 47 | 22 | 69 |
| 2019 December | 23 | 19 | 42 |
| 2019 November | 23 | 21 | 44 |
| 2019 October | 32 | 20 | 52 |
| 2019 September | 22 | 21 | 43 |
| 2019 August | 29 | 24 | 53 |
| 2019 July | 24 | 18 | 42 |
| 2019 June | 10 | 11 | 21 |
| 2019 May | 40 | 34 | 74 |
| 2019 April | 27 | 13 | 40 |
| 2019 March | 17 | 12 | 29 |
| 2019 February | 30 | 33 | 63 |
| 2019 January | 30 | 25 | 55 |
| 2018 December | 32 | 31 | 63 |
| 2018 November | 37 | 29 | 66 |
| 2018 October | 48 | 26 | 74 |
| 2018 September | 41 | 11 | 52 |
| 2018 August | 29 | 16 | 45 |
| 2018 July | 7 | 4 | 11 |
| 2018 June | 0 | 1 | 1 |
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