A key element in the treatment of Adult Respiratory Distress Syndrome (ARDS) is improvement in oxygen delivery to match metabolic demands. Conventional modes of ventilation have decreased mortality (50%) very little. We have done a retrospective analysis of 30 surgical patients who were treated with pressure-controlled inverse ratio ventilation. Mortality was 10%. Arterial oxygenation improved from 40.8 ± 12.2 mm Hg to 13.8 ± 47.2 mm Hg, while Pco2decreased from 37.8 ± 7.6 mm Hg to 31.1 ± 5.9 mm Hg. Simultaneously, with the use of pressure-controlled inverse ratio ventilation, minute ventilation could be decreased by 30%, which may be secondary to increased O2delivery to the tissue. Our data indicate that pressure-controlled inverse ratio ventilation may be beneficial to surgical patients with ARDS.