The case study is an actual operating system where Variable Air Volume (VAV), Direct Digital Control (DDC), and Smoke Management have been applied to a hospital nursing wing. A discussion of design criteria, design alternatives, actual performance, outdoor air and total air change rates, room pressurization, volumetric flow rate tracking, reliability, and energy is included.VAV and DDC systems actually have some performance and reliability advantages in comparison ’to constant volume and pneumatic control systems, particularly when backup devices and strategies have been provided. In the case study there is a significant energy advantage to variable air volume systems in comparison to constant volume systems.Units: Dual