An increasing number of critically ill patients need to be managed in emergency departments worldwide. Numerous theories have attempted to explain the growing number of critically ill patients presenting to emergency departments, including the complex medical problems of an expanding elderly population in countries
such as the USA. The situation in South Africa is exacerbated by HIV and trauma epidemics. Critically ill patients who require intubation and mechanical ventilation often need to be treated for extended periods in emergency departments. It is therefore no longer acceptable to apply a single strategy of ventilation for all such patients. This is especially true with increasing awareness of the complications of mechanical ventilation, such as barotrauma, volutrauma and biotrauma. In this new and challenging environment the emergency physician is expected to be familiar with the mechanical ventilators in his/her unit and to be able to select an appropriate strategy for each critically ill patient requiring mechanical ventilation.