The DEXA-ARDS trial evaluated a structured course of dexamethasone in adults with moderate-to-severe ARDS. Patients were randomised to intravenous dexamethasone or standard treatment, with the main goals of assessing ventilator-free days and survival. The corticosteroid group had more ventilator-free days and lower 60-day mortality, suggesting that appropriately timed anti-inflammatory therapy may improve outcomes in selected patients with established ARDS. The study is clinically relevant because corticosteroid use in ARDS has historically produced mixed results depending on timing, dose and patient selection. DEXA-ARDS provides evidence for a relatively early, prolonged steroid regimen rather than short rescue courses. For practice, however, the findings should be interpreted in the context of the broader evidence base and individual contraindications. Steroids can affect glucose control, muscle strength and infection risk, and ARDS is a heterogeneous syndrome with multiple causes. The trial does not support indiscriminate steroid use in every patient with acute lung injury. Instead, it strengthens the rationale for considering corticosteroids when the clinical phenotype and timing are appropriate. DEXA-ARDS also fits the broader movement toward phenotype-guided ARDS treatment rather than treating all patients with severe hypoxaemia as biologically identical.