Poonam Vira

Acute Respiratory Distress Syndrome (ARDS) is one of the most daunting challenges in the field of critical care medicine, characterized by diffuse alveolar injury, severe hypoxemia, and high mortality rates despite the progress in mechanical ventilation and supportive care. The use of corticosteroids in the management of ARDS has been controversial in the past, with shifting attitudes being fueled by recent clinical trials, meta-analyses, and empirical data, especially with the COVID-19 pandemic. Corticosteroids are presumed to modulate the dysregulated host response that lies at the core of ARDS, given their anti-inflammatory and antifibrotic effects. This narrative review embarks on a critical review of the pathophysiologic rationale for the use of steroids in ARDS, reviews landmark clinical studies that have shaped current clinical practice and distils recent guidelines by major health organizations. The review also explores heterogeneities in steroid responsiveness based on the timing of administration, etiology of ARDS, and the unique phenotypes of individual patients. Through the synthesis of the latest evidence, this article seeks to provide clinicians with an integrated view of the judicious use of steroids in ARDS while promoting an evidence-based approach to improve patient outcomes.