However, neuromuscular blockade through continuous infusion should not be routinely used in patients with moderate-severe ARDS; Where available, ECMO in conjunction with low tidal-volume mechanical ventilation can be considered in the treatment of patients with severe refractory hypoxemia in whom standard therapy are failing; Routine use of high-frequency oscillatory ventilation (HFOV) in patients with moderate-severe ARDS is not beneficial, but may be harmful.