ARDS is a severe disorder affecting over 150,000 patients per year in the United States alone. The syndrome has multiple etiologies that to a larger extent determine the 60% to 70% mortality associated with the process. In spite of intense research, there is still no specific therapy of proven benefit that we can offer patients. Supportive measures designed to keep the patient alive long enough to allow the pulmonary lesion to heal are the mainstay of therapy. These measures are constantly being improved and increasingly require invasive high technology. Even with advances in treating established ARDS, careful attention toward prevention and day-to-day management of ARDS patients will be required to reduce the excessive mortality.