The article deals with conclusions the American-European consensus Conferences on ALI/ARDS and VALI and their impact on current protocol of mechanical ventilation. Re-targeting of goals of mechanical ventilation, which give priority to avoidance of lung damage with inappropriate ventilation pattern leads to introduction of lung protective ventilatory strategy. It is based on Lachmann’s concept of „open the lung and keep it open“. Barotrauma, volotrauma and atelectrauma are recognized as main determinants for lung damage. The causative relation between lung damage due to mechanical ventilation and its deleterious effect on extrapulmonary organs leading to multiple organ dysfunction was determined. Several prospective randomized trials (Amato, NIH) proved a decrease of mortality from ARDS to 38 %., and 31 % respectively. Although there is a consensus now about use of lower tidal volumes than in the past (6–8ml/kg ideal b.w), keeping plateau pressures less than 30cmH2O, setting of PEEP remains controversial.Various methods ofPEEP adjustment was proposed based on analysis of PV curves and lower inflection point. However, their practical utilisation at the bedside remains controversial. There is a consensus about the need to tolerate a certain level of hypercapnia, even its therapeutic potential was proposed. Prone position has become increasingly used worldwide as a part of rescue procedures in early ARDS. Besides its traditionally accepted pivotal role in improvement of arterial oxygenation, it seems to play an important role in the improvement of CO2 elimination. Another promising strategies requiring future research include various techniques of recruitment and non-invasive ventilation. A search for subgroup of candidates who would profit from non-invasive ventilation is needed. HFO appears to be another promising technique of the lung protective ventilation strategy. Finally, some new experimental interventions (pharmacological and adjunctive ventilatory measures) are discussed. Some of them (iNO, almitrine), although failed as a isolated intervention in terms of improving outcome, might prove to play positive role when used in combination with prone position.

        Key words: mechanical ventilation – ARDS– protective lung ventilation strategy – ventilator associated lung injury – positive end expiratory pressure – prone position – recruitment manoeuvres