Transport of the ARDS patient is fraught with risk. These patients are at high risk of decompensation, which can be disastrous in the back of an ambulance or helicopter. The primary goal for critical care transport teams should be safe arrival of both the crew and patient to their destination. As such, if patients are achieving an adequate oxygen saturation at the referring facility, the better part of valor is to continue the current course, even if ventilator settings are suboptimal. If ventilator changes need to be made due to inadequate oxygenation, ventilation, or other factors, strong consideration should be given to LPV settings. Review the management literature behind ARDS management in 2020 with Chris Shaw, MD.