The clinical management of adults with acute respiratory distress syndrome (ARDS) continues to progress and evolve. In this review we provide updates across the domains of ventilatory management, ventilatory adjuncts and pharmacotherapy, categorizing these as Current Standards –those for which there is a strong evidence-base and which should be widely implemented – and Evolving Standards – those for which there is rationale but which might not yet be applied in all settings because of weaker evidence or feasibility.