Mechanical ventilation in medical departments: a necessary evil, or a blessing in bad disguise?

摘要: In most countries there is a mismatch between demand for intensive care unit (ICU) beds and ICU bed availability. Because of policy low ICU-bed reimbursement this much more profound in Israel, which arguably has the lowest number beds/1000 population OECD countries. Increasing mechanical ventilation led to an ever-rising presence ventilated patients medical departments, may reach up 15% or beds, especially during winter months, posing serious challenges such as: delivery adequate treatment, guaranteeing patient safety, nosocomial infections, emergence spread resistant organisms, dissatisfaction among family members nursing staff, as well enormous direct indirect expenses. This paper assumes that no change will occur near future. We, therefore, describe issues should ideally be addressed together order cope realistically with increase mechanically departments. First, all departments operate 5-bed augmented room one dedicated nurse per shift. Medical residents receive mandatory 3-month rotation their first year residency, attending physicians training vasopressor support, point-of-care ultrasound central venous catheterization. Second, required discuss fill relevant forms advance directives elderly and/or chronically ill patients. Third, rules terminal extubation established, even if only applied infrequently. Finally, co-payment considered families demanding possible treatment spite contrary advice, considering these patients’ status. Implementation recommendations require decision making Ministry Health, Scientific Council Israeli Association, professional societies (for internal medicine practice) finally by leadership individual hospitals.