Airway pressure release ventilation (APRV) is an inverse ratio, pressure controlled, intermittent mandatory ventilation.We aimed to report our experience with the use of APRV in management of acute respiratory distress syndrome (ARDS). METHODS: Patients with ARDS were mechanically ventilated; then, shifted to either synchronized intermittent mandatory ventilation, pressure control; Group I, or to APRV; Group II. The following parameters were monitored and compared after 1h, 6 h, and 24 h: vital signs, ABGs, and ventilatory parameters [VT, RR, P peak, FiO2, PEEP]. RESULTS: Thirty patients were enrolled. No significant difference between both groups in demographic, baseline clinical and gasometric parameters,and outcome. A significantly higher VT (p0.01) was found in Group II after 1 h, 6 h, and 24 hours. There were no significant differences in oxygenation or static compliance between both groups at any time. CONCLUSION: In patients with ARDS, compared with conventional ventilation, APRV offers better alveolar ventilation, similar oxygenation at the same safe inspiratory pressure level with less hemodynamic compromise, and without the need for neuromuscular blockade.