OBJECTIVES:  To analyze the clinical symptoms, treatment pattern, outcomes and factors associated with total cost of treatment. METHODS: A retrospective cross sectional study was conducted in tertiary care hospital. The patient details such as demographical data, clinical features, treatment and outcome were collected from the Medical Records Department. The total cost of treatment was collected from Finance Department. Data were analyzed by using SPSS 20.0 RESULTS: Mean age of the study population was found to be 42.7±18.2 year with majority of male 94(52.2%). Sepsis (59(32.8%)) was the most common etiology for ARDS in our study population. Analysis of 180 cases showed that total number of hospitalization days were 1793 and total cost of treatment was 11,005,448 INR. The patients who received corticosteroid therapy before 48 hours had better recovery rate. Mean ventilation days in the group of patients who received early glucocorticoid therapy were less (9.29±6.06) then those who received late therapy (13.64±6.03) CONCLUSIONS:  Mortality rate associated with ARDS was relatively high. Management with steroids has no special benefit in reduction in mortality rate. Time of start of steroid therapy plays an important role in the management and was observed that early start of steroid therapy showed better recovery rate as well as reduction in hospitalization and ventilation days. The total treatment cost for the management of ARDS is relatively high.