Acute Respiratory Distress Syndrome (ARDS) is an acute inflammatory pulmonary injury in which marked oedema of the lungs causing progressive impairment of gas exchange, atelectasis, and decreased lung compliance. Over the years, several innovative methods to control the lung injury had been studied. Improvement in ventilation strategy has resulted in reduce mortality is ARDS patients. Meanwhile, adjunctive therapies such as inhaled nitric oxide, exogenous surfactant administration, patient positioning and immune-nutrition are other methods which may further improve the outcome of this condition. The only clinically proven method that can alter the survival of patients with ARDS is the use of low tidal volume strategy. The adjunctive therapies although as attractive as they may appear, remained controversial and need evaluation in larger clinical trials. Whether any single modality used in the treatment of ARDS has a significant effect on overall mortality remained to be explored.