The Critical Path: When Breathing Becomes an Emergency

4 MINS

# The Critical Path: When Breathing Becomes an Emergency

In critical care, there are moments when breathing stops being a reflex and becomes an emergency. ARDS, sepsis, trauma, massive aspiration, anaphylaxis — different triggers, one shared urgency: the lungs cannot maintain life without immediate help.

Unlike obstructive or restrictive disease, there is no slow warning. Unlike infection, there is no gradual drift. The critical path is instantaneous — a cliff rather than a slope.

Reading the Crisis in Seconds

When a patient hits the critical path, clinicians must read the crisis in real-time:

PaO2/FiO2 ratio plunging — oxygen exchange failing rapidly

Severe dyssynchrony despite sedation — the body fighting the machine

Rising driving pressures — plateau pressure climbing breath to breath

Shock worsening with every failed oxygenation step

CO2 retention despite maximal respiratory effort The chest rises, but gas exchange doesn't follow. This is where the ventilator transforms from a tool into life support itself.

Where AI Becomes a Silent Partner

In these critical moments, AI can serve as a silent partner in survival:

Anticipating de-recruitment before it becomes visible

Flagging harmful pressure rises that human monitoring might miss

Predicting hypoxemia minutes early — buying precious time

Guiding lung-protective strategy through complex parameter optimization

Continuous monitoring while clinicians fight the larger battle The critical path reminds us that in crisis, breath is both fragile and fierce.

The Balance of Man and Machine

Machines act. Clinicians decide. Intelligence helps bridge the gap so that the next breath has a chance.

In healthcare technology, our role is to build systems that support this balance — giving clinicians the insights they need while preserving their autonomy to make life-saving decisions in split seconds.

Every breath counts. Every second matters. And technology, when designed thoughtfully, can help ensure more patients survive the critical path.

When the Breath Leads: Lessons from Ventilation Modes

Nandhini skipped presentations and built real AI products.

Nandhini Sivakumar was part of the September 2025 cohort at Curious PM, alongside 13 other talented participants.