Background: High mortality is associated with acute respiratory distress syndrome (ARDS). Methods: The study was a retrospective observational study on 39 patients with moderate to severe ARDS admitted between July 2010 and January 2013. Criteria for transition to Airway Pressure Release Ventilation (APRV) included failure to wean down FiO2 below 60% after 24 hours, hemodynamic instability due to high positive end-expiratory pressure (PEEP), and failure to maintain plateau airway pressure below 30 cm H2O. We compared the outcome of mandatory ventilation (CMV) and APRV groups with particular concern to the duration of mechanical ventilation, the requirement for tracheostomy, the requirement for vasopressors, and survival to ICU discharge. Results: Twenty-four males and 15 females were included in the study with a mean age of 42 years (±24). Fourteen out of them fulfilled the criteria and were shifted to APRV within 24 hours of initiating mechanical ventilation. Ten out of 14 (70%) patients in the APRV arm survived ICU discharge versus 16 out of 25 (64%) patients in the CMV group (p 0.45). Survivors in the APRV group spent significantly shorter periods on mechanical ventilation than survivors in the CMV group (9.6 vs 12.1 days, p 0.03). Furthermore, APRV patients required significantly fewer tracheostomies and less vasopressor. Conclusions:  We concluded that APRV could be effectively used as a rescue mode of ventilation in patients with severe ARDS. Although our study does not show any mortality benefit of using APRV over CMV, there were shorter ventilation days and ICU stay days using APRV.