Some previous studies have demonstrated that open lung biopsy (OLB) is a useful and acceptably safe diagnostic technique for patients with ARDS [7] [8] [9] . In the study by Papazian and colleagues [7] , the results of OLB directly altered the therapeutic management for 34 of 36 patients with ARDS (94%), and the OLB complication of an air leak occurred in five patients (14%). The OLB results obtained by Patel and colleagues [8] led to a change in management in the majority of 57 patients with ARDS, the addition of specific therapy for 34 patients (60%), and the withdrawal of unnecessary therapy in 24 patients (37%); major complications occurred in four patients (7%). However, in both studies the duration from intubation to OLB was long: in Papazian and colleagues' study [7] the range was 5 to 89 days, and in Patel and colleagues' study [8] it was 0 to 25 days. This retrospective study attempted to evaluate the utility and safety of OLB in patients with clinically suspected non-infectious early-stage ARDS.