Abstract
The drive to breathe is a fundamental human and biologic behavior, regulated by a complex system of checks and balances in the body. When respiratory mechanics are deregulated by injury, infection, coma, or a host of other conditions, the biologic equilibrium shifts into a state of respiratory failure. When this occurs, mechanical ventilation can be a life saving therapy. While commonplace in developed countries, critical care is at its infancy in many developing countries [1], where basic technology is often not available. Thus, while many lives are saved in developed nations through the provision of mechanical ventilation, patients in many developing nations often die from otherwise reversible causes due to lack of resources, education, and training. In this viewpoint paper, we will explore arguments in support of and against the provision of one vital resource – mechanical ventilators – in resource–poor settings. Furthermore, we will address both the benefits and challenges in implementing a program of increased provision of mechanical ventilators. Lastly, we will provide some solutions to address potential barriers to this initiative.
Highlights
The drive to breathe is a fundamental human and biologic behavior, regulated by a complex system of checks and balances in the body
While respiratory failure may be fairly easy to diagnose clinically, it is a consequence of a primary disease process – as a secondary process, collection of epidemiologic data are challenging in resource–poor settings
This results in the comparative epidemiology of critical illness and respiratory failure being heterogeneous [3,4]
Summary
The epidemiologic data regarding the burden of respiratory failure in developing countries is poor and may potentially be underrepresented due to large proportion of uncaptured data in patients in whom intensive care was never initiated in the first place due to perceived futility of treatment. While it has been recognized that NCDs are beginning to account for a larger burden of disease in developing countries [5], decompensated NCDs (ie, heart failure exacerbations) commonly require critical care and mechanical ventilation. The limited data comparing critical care in Europe versus developing nations confirms that patients in developing countries tended to be younger and had an improved prior health status [7,8]; the potential for recovery and productivity exists. An example of this situation is care for young patients with traumatic brain injury (TBI). While mechanical ventilation can be viewed as a prolonged task in some patients, the majority of patients would only require a short course of mechanical ventilation.This is because the four most common admission criteria requiring
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