Acute respiratory failure (ARF) results from a disorder in which lung function is inadequate for the metabolic requirements of the individual. ARF in critically ill patients is associated with mortality rates of between 40 and 65 % [1-13], and represents a wide spectrum of syndromes with different severities, which should be viewed in the context of the underlying pathology and associated organ dysfunction. Most of the published literature has focused on the severest forms of ARF, namely acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).

Mechanical ventilation is imperative in many forms of ARF, with additional concerns about associated complications, e.g., hazards related to endotracheal intubation [14], ventilator induced lung injury (VILI) [15, 16] and ventilator associated pneumonia (VAP) [17]. Clinical and experimental evidence [15, 16, 18-20] suggest that mechanical ventilation may influence end organ function, a major determinant of outcome in this population.

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