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.