A range of interventions has been devised to try to extend the potential range for conventional ventilation, as well as alternative strategies to support patients with respiratory failure beyond the current limits of conventional ventilation. Given that in the majority of patients acute respiratory distress syndrome (ARDS) is reversible, placing the patient in the prone position during conventional ventilation can improve oxygenation failure in this setting. Recruitment manoeuvres (RMs) are used to improve the volume of aerated lung, and consequently hypoxaemia, principally in patients receiving conventional ventilation for ARDS. In adult practice in the UK, high-frequency oscillation (HFOV) is generally used as a rescue for ARDS patients with refractory hypoxaemia on conventional ventilation. Extracorporeal CO2 removal potentially offers a rescue intervention in patients with severe hypercarbic respiratory failure. Transtracheal gas insufflation (TGI) appears a promising complementary technique to mechanical ventilation.