Automation to improve lung protection

Lung protective ventilation, usually referred to as ventilation with low tidal volumes ( V T ) and low inspiratory pressures (Pinsp), has repeatedly been shown to reduce mortality in patients with acute lung injury [1]. Conservative oxygen supplementation, a strategy that prevents arterial hyperoxemia through restricted use of oxygen [2], could be seen as another way to protect the lungs as use of low fractions of inspired oxygen (FiO 2 ) reduces the direct toxic effects of oxygen on pulmonary tissue. Ventilation with low driving pressure (Δ P ) and less mechanical power (MP) may also improve outcomes [3, 4 Targeting low V T and low pressures is a rather simple task, as it often involves nothing more than setting V T that suits the ideal bodyweight. Conservative oxygen sup-plementation may also be seen as not so difficult, notwith-standing that use of low FiO 2 increases the risk of arterial hypoxia. Targeting low ΔP can be more of a challenge. ΔP is simple to monitor as it requires a simple calculation at the bedside, and a reduction in ΔP can be straightfor-wardly achieved by limiting V T [3], that is when V T are not already low. Use of high positive end-expiratory pressure (PEEP) may decrease ΔP if it increases the size of the functional lung. However, high PEEP may not always recruit collapsed lung units, and can instead cause pulmonary overdistention, thereby increasing ΔP. Targeting less MP is by far the most complex and difficult intervention. MP is not so easy to monitor as it requires a complex formula that uses V T , Pinsp, ΔP, inspiratory flow, and also respiratory rate