The Acute Respiratory Distress Syndrome (ARDS) is a well-known pathology in critical care medicine. ARDS can result from many pulmonary and non-pulmonary pathological insults. It is characterised by intractable hypoxia, diffuse alveolar damage, accumulation of protein rich alveolar fluid, and it can lead to multiple organ failure. The lack of objective clinical diagnostic tests and disease specific treatments are the reasons that ARDS remains a clinical diagnosis with high mortality. This challenge is met with multi-centre task forces assembled specifically to address current practices. Many current treatments and diagnostic algorithms, namely the Berlin definition of ARDS, have come from such cooperation. Indispensible in the treatment of ARDS is low volume mechanical ventilation with avoidance of excessive airway pressures, which is know as lung protective ventilation. Its role as well as the role of current supportive treatments including: fluid management, extracorporeal membrane oxygenation, sedation, neuromuscular blocking agents, and recruitment manoeuvres will be discussed.