Acute Respiratory Distress Syndrome still high has a mortality rate. There are many causes for respiratory failure including sepsis, aspiration, pneumonia, pancreatitis, chest trauma, transfusion, and so on. However, not only respiratory failure, but the mechanical ventilation itself could induce lung injury additionally. Recently there has been a new definition of ARDS that is based on the clinical findings, time course of onset, and PaO2/FIO2 with more than 5 cmH2O of PEEP. It does not include heart failure and over infusion. Respiratory care for ARDS is going to change, as a result of recent research into respiratory management. In this review we describe respiratory care evidence for ARDS in terms of the Berlin definition, the history of naming ARDS, pathophysiology, etiology, ventilator management that are tidal volume, PEEP, High frequency ventilation (HFO), non-invasive positive pressure ventilation (NPPV), and airway pressure release ventilation (APRV). The physiotherapy of the prone positioning and recruitment maneuver (RM), Extra Corporeal Membrane Oxygenation (ECMO), nitroxide (NO), intravenous muscle relaxants, and so on will be discussed
