In the India, the patients admitted to the ICUs between 2020 and 2022 increased significantly compared to the past ten years.¹ Annually over 240,000 patients across the country needs mechanical ventilation in the emergency department (ED) which is 10 % of all ED admissions. A one-quarter of these patients remain in the ED for more than 5  hours, and their mortality is significantly higher than the other patients admitted to the ICU. In Japan, it is reported that 46.4% of patients requiring MV are monitored in non-ICU settings. The number of EDs with special care areas such as critical care units or ED intensive care units (ED-ICUs) for treating critically ill patients are increasing. Emergency physicians are obliged to have the required skill set to follow patients in MV, even if it is short-term, because it affects the patient outcome.