Although not allowing one to state conclusively that a particular combination of approaches to CMV and adjuncts to CMV affect outcome, the results are encouraging. Independently, none of the modalities discussed-HFV, ECMO, NO, or PLV-have shown a statistically significant improvement in outcome except NO. With NO, improvement is only in a small select group of patients; however, in combination there may be greater overall impact on outcome. With each of these modalities, more information is needed on how to apply each technique optimally. It is easy to see that modification of the experimental protocol in each study may have altered results. Clearly, more laboratory and clinical studies examining the combined use of these therapies are needed, as is identification of the specific patient populations where these combined therapies may be most effective.