OBJECTIVES: The objective of the study is 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: The study showed higher predominance in males 94(52.2%) with a mean age of 42.7±18.2 years. Sepsis 59(32.8%)) was the most common etiology for ARDS. Analysis of 180 cases showed that the total number of hospitalization days of all the ARDS patients was 1793 and total cost of treatment was 11,005,448 INR. The patients who received corticosteroid therapy before 48 hours had better recovery rate. The mean ventilation days in the group of patients who received early glucocorticoid therapy were less (9.29±6.06) when compared with late glucocorticoid therapy (13.64±6.03). Various categorical variables like rhonchi, start of corticosteroid therapy, tetracycline, other antibiotics, adrenaline, dopamine and oxygenation were found to be statistically significant. The patients with corticosteroid therapy and without corticosteroid therapy had average difference of INR 500 without any clinical benefit.  CONCLUSIONS: The mortality rate associated with ARDS was relatively high. Management with steroids has no special benefit in reduction of mortality rate. 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.