The LLSA readings are offered to keep clinicians up to date on current trends in medicine after we have graduated from residency and are practicing in the middle of a non-academic landscape. As I was reviewing these different articles looking for something to write about, I came across this article by Dr. Manthous. His article tackles intubation and positive pressure ventilation using case-based presentation that is germane to our practice. Some takeaway pearls include maintaining plateau pressures at <30 cm H20 (remember plateau pressure is the pressure at the alveoli not the peak pressure which is the pressure of the larger airways) to avoid volutrauma. He also teaches about the inspiratory to expiratory ratio of 1:5 or less to allow exhalation in severe asthmatics (to prevent air trapping or stacking). I was so excited about the article and the way it truly teaches, I wanted to share it with you all. I think it would be valuable to start a conversation about ventilators so that some of the mysteries can be addressed. Enjoy and let the conversation begin.