During a one year period, 78 patients at the Denver General Hospital required mechanical ventilation following inury. Thirteen patients were judged to have Respiratory Distress Syndrome. Of these, 9 had classic early onset RDS but, with intravenous fluid restriction following resuscitation, diuretics and careful mechanical ventilation, all recovered. Six patients, all of whom were septic, developed late onset RDS 5 or more days after injury; 5 died. Disparity between early and late onset RDS is emphasized; the one with good, the other with dismal prognosis. The current need is to improve treatment of late onset RDS, which frequently is associated with bacterial infection.pOST-TRAUMATIC respiratory distress syndrome (RDS) came into explosive prominence during management of combat casualties in the Vietnam War. 13.18.22,25-27 Since then an enormous volume of literature has evolved concerning its pathogenesis, recognition and care.4'6'8 Main emphasis has remained, as during the War, on development of respiratory failure in the immediate post-injury period associating the syndrome with chest wall contusion,22 blast,21 multiple blood transfusions,10'19 fat embolism,2"2 aspiration,5 shock,9 cerebral hypoxia, and fluid and sodium overload.26 In a series of classic articles, Ashbaugh" 3"18'23 described the adult respiratory