Mechanical ventilation is a sophisticated technique with very narrow therapeutic ranges i.e. highly efficient and able to keep alive the most severe patients, but with considerable side effects and unwanted complications if not properly and timely used. Computerized protocols, closed loop systems, decision support, all terms which need to be defined, may help making mechanical ventilation safer and more efficient. The present paper will provide a short overview on technical and engineering considerations regarding closed loop controlled ventilation as well as tangible clinical evidences supporting the previous statement.