The acute respiratory distress syndrome is a life-threatening condition that is associated with significant morbidity, with mortality rates approaching 40 to 60%. ARDS is diagnosed based on the 1994 American-European Consensus definition as an acute onset of Hypoxemia with a ratio of the partial pressure of arterial oxygen to the inspired fraction of oxygen of 200 mm Hg or less, Bilateral infiltrates on a frontal chest radiograph, and No clinical evidence of pulmonary arterial hypertension or a pulmonary artery occlusion pressure of 18 mm Hg of less in the presence of a pulmonary catheter. Corticosteroids are an attractive treatment option in the management of ARDS/ALI. Although there appears to be a benefit of low dose steroid in the early stages of ARDS, this evidence is based on small trials that have used varying doses of steroids for varying duration. Larger trials, that are appropriately stratified, are required before firm treatment recommendations can be suggested.