The development of respiratory management for acute lung injury induced by acute respiratory distress syndrome has been directed toward improving survival. The lung-protecting approach such as lower tidal-volume ventilation with the limitation of upper-airway pressure and open-lung approach such as higher positive endexpiratory pressure ventilation and prone positioning may contribute to the survival together with the development of the systemic-supported care. On the other hand, the evidence of the effects of noninvasive positive pressure ventilation on various respiratory insufficient condition has been increased, and the indication has also been expanded. The new technology has developed the function of continuous positive airway pressure and adaptive servo ventilation, and contributed to the treatment of sleep-disordered breathing. Now it demands us to completely manage these new technologies.