The advances in pulmonary support over the past year have focused on newer, alternative modes of mechanical ventilation in the patient with acute respiratory failure. This has been influenced by the recent data showing that significant damage to the lung results from mechanical ventilation itself. The focus has been in the area of decreasing the large tidal volumes and high airway pressures usually required for ventilation of the poorly compliant lung. These alternative modes of ventilation form a spectrum from simple changes in the ventilator settings all the way to liquid breathing. Other advances in pulmonary support include further experience in use of noninvasive ventilation, weaning from mechanical ventilation, and medication delivery systems.