Abstract: Acute respiratory distress syndrome (ARDS) is a life-threatening non-cardiogenic pulmonary edema. Despite lung-protective ventilation strategies serving as the cornerstone of ARDS treatment, some patients still fail to effectively alleviate hypoxemia or reduce ventilator-induced lung injury. Recent studies have revealed that chest or abdominal compression can improve lung compliance and mitigate alveolar overdistension during the end-inspiratory phase in ARDS patients. Chest wall compression, as a method of applying weight to the ventral aspect of the chest in supine patients, holds potential clinical benefits and is recognized as one of the diagnostic tools for alveolar hyperventilation in ARDS patients. This review aims to analyze the application of chest wall compression in the ventilation of ARDS patients from both physiological and clinical perspectives, exploring its mechanisms and clinical significance. Ultimately, it seeks to provide novel insights and evidence for the treatment of ARDS patients.