Adult respiratory distress syndrome (ARDS) is a severe disease that carries a poor prognosis (50 to 60% mortality). Although modern ventilatory techniques, especially positive end-expiratory pressure ventilation, have reduced the mortality rate somewhat, they are still far from serving as the ideal solution to this grave condition. High-frequency positive pressure ventilation (HFPPV) is a relatively new technique that enables effective alveolar ventilation without creating high intrapulmonary pressures. HFPPV using a conventional ventilator, Bennett MA-1B (Suffex, England), was tried in a 22-yr-old man with ARDS due to pyocyanea sepsis, who had failed to respond to conventional ventilation. A dramatic improvement was achieved within 60 min of increasing the ventilatory rate from 12 to 80/min, with a concomitant decrease of tidal volume from 12 to between 2 and 23 ml/kg. HFPPV may be a useful alternative method in the treatment of patients with ARDS.