The Rise of the Machines: Why the future lies with less injurious adaptive ventilation strategies

It has been 60 years since Bendixen, Hedley-White, and Laver described the progressive atelectasis and resultant hypoxemia that resulted from prolonged mechanical ventilation. A proposed solution was to raise the tidal volume (VT) from those recommended by Radford’s nomogram for “proper ventilation” to 10 -15 ml/ kg. It was less than four years later that Acute Respiratory Distress Syndrome (ARDS) was first reported. Since then, clinicians and researchers have been searching for the ideal ventilation strategy to minimise the harm and optimise the outcomes from ventilatory support in the critically ill.