Abstract: Acute respiratory distress syndrome is a condition of varied etiology characterized by the acute onset of hypoxemia, reduced lung compliance, noncardiogenic pulmonary edema and diffuse exudative lesions of both lungs. Although protective ventilation strategy has been implemented in clinical practice, an estimated 10%-15% of the deaths in ARDS are caused due to refractory hypoxemia. In these cases, clinicians may resort to “salvage therapies”. These include prone position ventilation, application of early neuromuscular blockers, various recruitment maneuvers, unconventional ventilation modes, inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation. All the salvage therapies have been associated with improved oxygenation, but whether to reduce mortality and improve prognosis is controversial. Each of the salvage therapiesis associated with its own risks and benefits, specific treatment strategies should be adopted according to the individual situation of patients.

Key words: acute respiratory distress syndrome, hypoxemia, mechanical ventilation, ventilator induced lung injury