This document summarizes various adjunctive treatment strategies for acute respiratory distress syndrome (ARDS) including ventilatory strategies beyond lung protective ventilation, hemodynamic management, pulmonary vasodilators, surfactant replacement therapy, anti-inflammatory strategies, and corticosteroids. Prone positioning, inhaled nitric oxide, and prolonged corticosteroid treatment in refractory ARDS have shown benefits in oxygenation and survival in clinical trials. However, other strategies such as high frequency ventilation, liquid ventilation, and surfactant replacement have not demonstrated clear clinical benefits.