Osteopathic manipulation has been used to treat a wide range of diseases in largely outpatient settings. The authors describe the emergent use of osteopathic manipulative treatment to improve respiratory mechanics in a critically ill patient with acute respiratory failure. High-velocity mobilization of cervical and thoracic dysfunctions resulted in a decreased work of breathing, improved arterial oxygenation, resolution of tachycardia, and an overall improvement in the patient's clinical condition.