Corticosteroids have been used for the treatment of ARDS for the last 20 years; however, their benefits are still unproven.2Discrepancy of results from clinical trials may be explained by different doses and duration of administration, as well as patient selection and an excess of morbidity imposed by steroid-related side effects. However, the recent study by Meduri and coworkers3 sheds some new light on ARDS pharmacotherapy by demonstrating clinical improvement based on possible immunomodulatory effects of the steroid infusion, thus hastening the resolution of lung injury and organ failures. Common aspects among all studies showing benefits of steroids3–4 were the use of relatively lower doses, early infusion, and the selection of an extremely severely ill population. Moreover, these “successful” prospective studies had also similar limitations, the foremost one being a relatively small sample size with limited power for the detection of important outcomes (eg, hospital mortality). Therefore, these results must be viewed with caution because the morbidity burden associated with corticosteroids cannot be underestimated and a recent large multicenter clinical trial5 failed to show any significant improvement in the outcomes of patients with ARDS and severe sepsis (as disclosed by the results of the Corticus Study).