The management of acute respiratory distress syndrome (ARDS) with non-invasive ventilation (NIV) is controversial. We report a case of a 69-year-old patient who developed ARDS after elective total hip replacement. During a 33-day stay in the intensive care unit (ICU) his respiratory failure was successfully managed with intermittent NIV through a transparent ventilation helmet, when he became intolerant of the facemask. Nearly four days were spent almost continuously in the NIV hood. The origin of the ARDS was never confirmed; possible causes included amiodarone toxicity, atypical pneumonia and fat embolus. The patient remained awake throughout, never exceeded single-organ failure, his respiratory function improved gradually and he was eventually discharged home.

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