Prone positioning is widely recognized in critical care, but its role in patients supported by Extracorporeal Membrane Oxygenation (ECMO) remains a topic of debate. This session takes a critical look at the physiological rationale and examines the existing evidence to determine whether prone positioning offers measurable benefits for ECMO patients.

Hypertonic saline (HTS) has long been used to induce sputum in non-ventilated subjects. In recent years, 3%, then 7% and now 10% HTS is routinely used as a wetting agent or semi-mucolytic in all ventilated patients. Does the evidence support routine use and is this practice justified? HTS is inexpensive, safe and has few contraindications, its use is easily justified.

Changes in climate around the world have resulted in significant impacts on human health. In 2024, wildfires raged in California, Hawaii and the Northeast. The acute effects of smoke inhalation on health are well known, but the impact of particulate matter in the air on patients with chronic lung disease and reactive airway disease also represents a hazard. The long-term effects on population health are only now beginning to be educated. This lecture will help attendees understand the many effects and impact of wildfire smoke on chronic lung disease patients.

In critically ill patients, the method for determining the optimal level of PEEP limits intratidal decruitment and provides the best oxygenation and compliance, while avoiding hemodynamic compromise, is elusive and debated. Another potential indication and clinical goal for the personalization of PEEP may be to positively affect spontaneous breathing and the ventilator liberation process. This presentation will discuss the evidence and potential ways in which PEEP may be adjusted to impact spontaneous breathing and liberation from mechanical ventilation.

Recently identified mechanisms underlying asthma, cystic fibrosis, and other respiratory diseases suggest differences in pathophysiology and response to treatment based on specific phenotypes. This includes response to anti-inflammatories, bronchodilators and CTFR proteins which impact the degree of fibrosis in multiple organ systems. This presentation will discuss results from several large ongoing clinical trials, as well as new treatment and diagnostic modalities.

This session addresses the complexities involved in transitioning patients from passive mechanical ventilation to assisted modes. Attendees will gain a deeper understanding of the physiological, technical, and patient-centered challenges and learn strategies to overcome these barriers to ensure optimal patient outcomes.

Weaning from mechanical ventilation in the acute care setting can present unique physiological and psychological challenges for certain patient populations, often resulting in prolonged and complex weaning that require organizational coordination of care. This lecture will focus on the barriers to successful weaning and tailored interventions to evidence-based approaches involved in weaning patients with COPD, neurologic and neuromuscular disorders, and patients with prolonged or long-term weaning from mechanical ventilation.

This debate addresses a crucial question in resuscitation science: Should precision ventilation during CPR be a top priority, or does it risk overcomplicating an already high-stakes intervention? Can tailoring ventilation improve outcomes such as time to return of spontaneous circulation (ROSC) and mortality? Or does it lead to cognitive overload, distractions from critical tasks, and over-reliance on technology, where mastering the basics may be more effective than adding layers of complexity? Attendees will gain valuable insights into this issue as two experts present opposing views supported by evidence and clinical experience.