The acute respiratory distress syndrome (ARDS) represents 7.7 of the intensive care population, and is associated with great morbidity and mortality (58 ). Frequently, the mortality can be attributed to more than one cause. Refractory hypoxemia is uncommon (15 ) and most of the patients also have multiple organic dysfunction, sepsis or septic shock. Although there are many publications concerning series of cases and clinical trials using steroids as a part of the treatment of ARDS, this issue remains controversial. In this article the role of steroids in the ARDS is evaluated by analysis of the available literature. We conclude that steroids are useful in a subgroup of patients with unresolving ARDS, after ruling out an active infection or after treatment with antibiotics.