Each once there are a great proportion of critical ill patients with acute respiratory distress syndrome and acute lung injury in the setting of the intensive care units those patients are in continuous risk because the severity of our patient each once is worse and can be development refractory hypoxemia with severe damage of statics and dynamics mechanical pulmonary properties and seriously affects over ventilation, if no take a strategy suitable can increase the morbidity and mortality even in mechanical protect ventilation. can gives a security mode of mechanical ventilation at this circumstances it is so difficult and dangerous, Thanks to the knowledge of gas exchange movements in the different compartments at the pulmonary air way through the high frequency oscillatory ventilation experience allows take in practice new tools in the mechanical ventilation field more security in terms of high tidal volume gives, less continuous monitoring of mechanical ventilation and prevent loss of pulmonary recruitment like happened whit high frequency oscillatory ventilation. There are a great experience with beneficial results in the management of this kind of patients with tracheal gas insufflation associated with protect mechanical ventilation under the principles of inertancy, convection, profile asymmetric velocities, turbulence, swirling, expiratory break, no mechanical peep, recruitment, mixed flow and collateral ventilation all this mechanisms are the fundaments of tracheal gas insufflation. Wherewith can be developments others systems of high flow and high concentration like VentuyMax known like high flow cannula system. Additionally is imperative think after the pulmonary rest offer through the tracheal gas insufflation monitoring the damage above named properties and the close loop ventilation systems like proportional assisted are useful in this management.

AIMS AND SCOPE:
1. Remain stress and strain theory.
2. Remain mechanic transductions inflammatory.
3. Immunomodulation of protect mechanical ventilation.
4. Antiapoptoic effect through tracheal gas insufflation and protect mechanical ventilation.
5. Understanding strategy tracheal gas insufflation.
6. Importance of close loop systems in weaning of acute respiratory distress syndrome patients.