OBJECTIVES: Various studies exploring the routine use of corticosteroids for management of acute respiratory distress syndrome have had controversial results. The aim of this study was to evaluate and compare randomized, controlled trials with observational studies (comparing historical controls) determining the efficacy and safety of steroids in management of Acute Respiratory Distress Syndrome in adult population. METHODS: English language, randomized control trial and observational studies were searched using different  databases like the Cochrane Central Register of Controlled Trials, Cochrane database of systematic reviews, PUBMED, SCOPUS, SCIENCE DIRECT (Key terms: corticosteroids, methylprednisolone, hydrocortisone, dexamethasone AND acute lung injury, adult respiratory distress syndrome, acute respiratory distress syndrome, ARDS, respiratory failure, septic shock; years: inception to February 2014). RESULTS: A total of 8 randomized control trial and 5 observational studies using variable dose and duration of steroids met the inclusion criteria. The Mantel-Hanzel odds ratio of corticosteroids decreasing mortality in patients of randomized, controlled trial was 0.822; 95% CI 0.480 to 1.408 whereas in observational studies was 0.552; 95% CI 0.134 to 2.278. The odds of corticosteroids associated infectious complications in patients of randomized, controlled trial was 1.118; 95% CI 0.557 to 2.247 whereas in observational studies was 1.662; 95% CI 0.981 to 2.816. CONCLUSIONS: A definitive role of corticosteroids in ARDS has not been established. However, current data from studies shows the result favouring use of corticosteroids in ARDS by decreasing the mortality associated. However, use of steroids is associated with a slight risk of increased infectious complications.