Conclusions
As noted at the beginning of this chapter, the overarching goal of positive pressure mechanical ventilation is to provide adequate gas exchange support while not causing harm. Important challenges face clinicians every day in providing mechanical ventilatory support. Two of the most important of these challenges are balancing adequate gas exchange with the risk of VILI in acute respiratory failure; and assuring patient comfort during interactive support in the recovery period. Over the last 2 decades several novel approaches have been introduced that may help clinicians address these challenges. Although all of these approaches have conceptual appeal, most still await good clinical outcome data to justify their widespread use.