The increased understanding of the pathophysiology of acute lung injury that has been achieved over the last decade has led to several new pharmacologic approaches for the prevention and management of ARDS. Based on in vitro information and animal models, many of these strategies are quite compelling. Nevertheless, to date, no specific pharmacologic approach for the prevention or treatment of ARDS has been validated conclusively in clinical trials. Active basic and clinical investigations are continuing, and it is hoped that these will lead to new therapies that can be applied by the clinician in the management of future ARDS patients.