Never give the lung the opportunity to collapse

Acute respiratory distress syndrome (ARDS) was first identified in 1967, as a syndrome associated with heterogeneous lung collapse and a very high mortality. It has been shown that maintaining homogeneous ventilation using mechanical ventilation can improve survival. Using our recent understanding that dynamic alveolar ventilation is viscoelastic in nature, we suggest that a superior technique to open and stabilize the lung would be to extend the time at inspiration, to recruit alveoli with each breath, and to set a very short expiratory time to prevent alveolar collapse. This has led us to develop a novel Time Controlled Adaptive (TCAV) protocol that uses the duration at inspiration and expiration to open and stabilize the lung.