Goal oriented ventilation in acute respiratory distress syndrome: a concept for optimal gas exchange at lung protective ventilation

Abstract The strategy goal oriented ventilation means that mechanical ventilation should aim at clearly defined immediate physiological objectives based upon the actual status of the individual patient. The immediate goals, which ultimately should lead to an optimal outcome, comprise normocapnia, oxygenation and lung protection. Obstacles of physiological nature on the way towards the goals are briefly discussed, as are strategies to overcome each of them. The challenge is to optimise all aspects of mechanical ventilation in order to reach all goals. For that purpose a holistic approach must be taken in which comprehensive information about patient status is taken into account. Shortcomings of available monitoring systems are underlined. On the basis of improved monitoring it should be possible to use computer simulation in order to come closer to the goals of mechanical ventilation, than what is possible on the basis of presently practised clinical routines.