Acute respiratory failure. Pregnancy entails many unique physiologic changes that make the management of ARDS both challenging and unique. Most of these women are young and in excellent health before their acute injury, and their survival should exceed that of the general population who develop ARDS. We advocate aggressive management of the suspected lung injury including early intubation and the institution of invasive hemodynamic monitoring. This approach ensures the most thorough assessment of the extent of the initial injury and allows rapid assessment of therapeutic maneuvers and their subsequent adjustment. Our goal is to reverse the initial insult early while avoiding further iatrogenic injury. Optimal management of the maternal-fetal pair requires the cooperation of an obstetrician well versed in cardiopulmonary physiology and physicians skilled in intensive care medicine. 