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Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of diffuse bilateral pulmonary infiltrates, normal pulmonary capillary wedge pressure (<18), and hypoxemia (PaO2:FiO2 < 300). ARDS can result from both direct and indirect lung injury and represents the pulmonary manifestations of the systemic inflammatory response syndrome (SIRS). Treatment aims at early diagnosis and correction of the underlying cause of ARDS. The mainstay of treatment is lung protective ventilation, or a combination of low tidal volume ventilation with increased positive end expiratory pressure (PEEP). Alternate modes of ventilation, other rescue therapies, and long-term neurocognitive and pulmonary dysfunction after ARDS are areas of intense research.