RESPIRATORY SYSTEM: Edited by Ewan C. Goligher and Eddy FanThe role of computer-based clinical decision support systems to deliver protective mechanical ventilationKhemani, Robinder G.a; Hotz, Justin C.a; Sward, Katherine A.b; Newth, Christopher J.L.aAuthor Information aDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California bCollege of Nursing and Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA Correspondence to Dr Robinder G. Khemani, MD, MsCI, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Mailstop # 12, 4650 Sunset Blvd., Los Angeles, CA 90027, USA. Tel: +1 323 361 2376; e-mail: email@example.com Current Opinion in Critical Care: February 2020 - Volume 26 - Issue 1 - p 73–81 doi: 10.1097/MCC.0000000000000688 Buy Metrics Abstract Purpose of review Mechanical ventilation of adults and children with acute respiratory failure necessitates balancing lung and diaphragm protective ventilation. Computerized decision support (CDS) offers advantages in circumstances where complex decisions need to be made to weigh potentially competing risks, depending on the physiologic state of the patient. Recent findings Significant variability in how ventilator protocols are applied still exists and clinical data show that there continues to be wide variability in ventilator management. We have developed a CDS, which we are currently testing in a Phase II randomized controlled trial. The CDS is called Real-time Effort Driven ventilator management (REDvent). We will describe the rationale and methods for development of CDS for lung and diaphragm protective ventilation, using the REDvent CDS as an exemplar. Summary Goals for achieving compliance and physiologic objectives can be met when CDS instructions are simple and explicit, provide the clinician with the underlying rule set, permit acceptable reasons for declining and allow for iterative adjustments. Copyright © 2020 YEAR Wolters Kluwer Health, Inc. All rights reserved.