Acute respiratory distress syndrome (ARDS) is one of the causes of death in critically ill surgical patients. ARDS is a rapidly progressive pulmonary disorder that manifests res-piratory failure. It is associated with postoperative infection, sepsis, and severe trauma, etc. The management of ARDS is complicate and targeting the underlying causes. In addition, many supportive managements such as nutritional support, prevention of stress ulcer and thromboembolism, with lung- protective ventilation strategies are necessary.