Adult respiratory distress syndrome (ARDS) is a special type of acute respiratory failure. 10 cases with ARDS were reported. Severe trauma, major abdominal operation and shock were the most common causative factors (9 of ten). All of six conscious patients felt chest dullness, shortness of breath, respiratory distress and accelerated respiratory rate. Rales in lungs were heard in 8 cases. Monitoring results: PaO2(FiO2 = 1) < 40kPa, P(A-a)O2 > 40kPa, PaO2/FiO2 < 300 in all cases; Qs/Qt > 30% in seven. In 5 of seven patients, chest X-ray showed abnormal shadows in the lung fields. PCWP 1.47-1.87kPa. 8 patients, whose failure organs were more than four, died, mortality rate was 80%. Clinical course of this group showed that ARDS and MOSF were two different kinds of syndromes, though they based on similar pathophysiologic mechanism. The insertion of a Swan-Ganz catheter and hemodynamic monitoring are helpful to the diagnosis of ARDS and the selection of the optimal PEEP.