The document provides a review of therapeutic strategies for acute lung injury and acute respiratory distress syndrome (ARDS) based on published evidence and guidelines. It summarizes definitions of severe ARDS, initial evaluation and interventions including low tidal volume ventilation and conservative fluid management. Further strategies discussed include recruitment maneuvers, high positive end-expiratory pressure, prone positioning, high-frequency oscillatory ventilation, inhaled nitric oxide, glucocorticoids, and extracorporeal life support. Recommendations are provided for each strategy based on risks, benefits, and evidence from clinical trials.