Care of patients with adult respiratory distress syndrome (ARDS) is supportive, consisting of attention to underlying causes, nutrition, fluid balance, and life support. The only commonly used treatment that is specifically for ARDS is positive end-expiratory pressure (PEEP) therapy. Data do not prove that use of PEEP or other procedures in intensive care units has changed the very high mortality rates (about 50%) of ARDS. However, progress has taken place, since ARDS populations seen today are much more ill and older that those seen in the past. Most progress thus far has been in technology (eg, better ventilation, dialysis, and monitoring methods). The next great strides will likely be in pharmacologic interventions (eg, monoclonal antiendotoxin antibodies for treatment of septic ARDS, antibodies to tumor necrosis factor, antioxidants, prostaglandin inhibitors, antibodies to leukocyte adhesion molecules). Many of these are already being tested in phase III clinical trials, but application of others is years away. In the meantime, survival rates will improve through competent medical management and support, with exquisite attention to the detailed needs of each patient.