The selective pulmonary vasodilatory effects of inhaled nitric oxide decrease pulmonary artery hypertension and improve arterial oxygenation in patients with ARDS without causing concomitant systemic vasodilation. Inhaled nitrix oxide therapy may decrease the prevalence of pulmonary edema, pulmonary barotrauma, and oxygen toxicity that occur with current ARDS treatment. The effect of nitric oxide on oxygenation and pulmonary artery pressure may allow more time for the lungs to recover. Initial results of clinical trials are encouraging; however, the impact of inhaled nitric oxide therapy on patients with ARDS remains unclear. Further research is needed to develop safe delivery systems and monitoring techniques for routine clinical use, to determine potential adverse and toxic effects of nitric oxide therapy on patients, and to determine the effects of long-term exposure to nitric oxide among healthcare workers. Concomitant administration of other medications with inhaled nitric oxide should also be investigated.