Mechanical ventilation: Is less, more?

M ECHANICAL ventilation has revolution. ized the treatment of critically ill and postoperative patients by making it possible to ventilate and oxygenate patients with markedly reduced lung function. It has facilitated advances in cardiac surgery, improved the survival of premature infants, and helped the recovery of trauma victims. Technological advances have resulted in the development of increasingly sophisticated modes of artificial ventilation, permitting the successful ventilation of very ill patients. Enhanced monitoring modalities have improved the safety of mechanical ventilation, allowing it to become a frequently used life-sustaining therapy. Yet like many rapidly advancing technologies there comes a time when it becomes necessary to rethink the direction and contemplate the consequences of what is being done. Mechanical ventilation is undergoing such a reexamination, from both scientific and economic perspectives. Many principles have been questioned, and the answers have often reversed what were previously considered basic tenets. This article reviews some of these issues and examines what has prompted this review process and the changes in practice that have ensued.