The diagnosis of acute respiratory distress syndrome (ARDS) should be considered in all patients with pneumonia, trauma, or sepsis who develop acute hypoxemic respiratory failure. There are 2 basic principles to adhere to at the time of an ARDS diagnosis: use the optimal mechanical ventilation strategy, and identify and treat underlying reversible inflammatory causes. A significantly lower mortality (31% vs 40%) was found in patients receiving lower tidal volumes. Once patients have achieved acceptable levels of oxygenation and positive end-expiratory pressure, efforts should be made to reduce ventilator support. Mobilizing patients early during critical illness may decrease subsequent neuromuscular complications.