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Methodsįorty-two consecutive patients with early moderate and severe ARDS were included. We sought to evaluate the relationships between dynamic variations in V D/ V T and extra-pulmonary microcirculatory blood flow detected at sublingual mucosa hypothesizing that an altered microcirculation, which is a generalized phenomenon during severe inflammatory conditions, could influence ventilation/perfusion mismatching manifested by increases in V D/ V T fraction during early stages of ARDS. Although increased dead-space ventilation ( V D/ V T) has been described in ARDS, its mechanism is not clearly understood. Ventilation/perfusion inequalities impair gas exchange in acute respiratory distress syndrome (ARDS).