In this issue of CHEST (see page 1281), Wongsurakiat and colleagues present data that highlights this very process. They document a change in ventilator settings over little more than a decade of observation (from 1990 to 2000). They investigated the ventilator management of cardiac arrest patients who were identified through a long-standing database and appropriately eliminated subgroups of patients that may have warranted special attention to ventilator settings (eg, COPD, ARDS, and other conditions). In that fashion, they were left with a group of patients whose management should be unencumbered by any special considerations and should reflect what would be considered the current best practice. Although this is a retrospective review, the authors were able to demonstrate definite changes in ventilator settings. Their major findings were a reduction in a 3-day average mean (± SD) set tidal volume (Vt) from 11.8 ± 1.5 to 8.4 ± 1.3 mL/kg (measured body weight) and an increase in the use of positive end-expiratory pressure (PEEP). In the first years of the study period, > 80%, and close to 90%, of patients had no PEEP added to their treatment, whereas by the end of the decade the converse was found, with < 20%, and probably closer to 10%, of patients receiving ventilation without PEEP. PEEP levels of ≥ 5 cm H2O were used in about 10% of patients in the first years, and this had increased to about 90% of patients at the end of the decade. These changes were associated with an increase in radiographically evident atelectasis (58% vs 43%, respectively), with possibly higher oxygen requirements, but no changes in other outcome measures, including high plateau pressures, pneumonia, number of ventilator days, or mortality.