Acute respiratory distress syndrome (ARDS)is the illness with complicated aetiology and multifactoral pathomechanism.ARDS can develop in patients who develop respiratory system diseases or illnesses of other organs,the mortality rate in children is estimated at about 45%.Treatment is difficult and includes the use of mechanical ventilation with positive end-expiratory pressure.The use of surfactant in children with ARDS increased oxygenation and allowed reduction of ventilation parameters,and decreased time spent on ventilation and in the ICU;the decrease in mortality has not been proved.It seems that the decision about the surfactant therapy should be undertaken as quickly as it is possible after establishing the diagnosis,because at that moment results of treatment are the best.There are questions about the dose of surfactant,the quantity of applications and time interval between them.Most researchers suggest that a single dose is sufficient.The key to the reduction of death rate among children with ARDS might be combined treatment with new methods of ventilation with smaller damage to the lung (HFO,HFOV,‘the open lung concept prone position and permissive hypercapnia),early therapy with surfactant,nitric oxide (iNO)or others vasodilatory drugs, and the correction of circulatory system dysfunction.

Keywords: ARDS, children, surfactant