As an Anaesthetist, with a special interest in Critical Care Medicine, I have seen the evolution of mechanical ventilation from two perspectives. In my presentation I will look at the historical aspects of mechanical ventilation and especially the differing needs of anaesthesia and critical care in driving the development. Complications associated with mechanical ventilation are now well documented and this has led to a resurgence of interest in less invasive and more physiological modes of ventilation. These complications, associated with mechanical ventilation, were initially described in terms of adverse physical effects, such as ‘Barotrauma’ and ‘Atelectrauma’.