Corticosteroids were administered to all patients as Meduri et al. [27] recommend in ARDS cases with low PO 2 /FiO 2 . Steroid use has been reported in some cases of H1N1associated ARDS without any adverse outcome [28] . However, some authors discuss the potential adverse effects of steroids in H1N1 infection, including higher mortality possibly related to virus spreading [29] . Although there is no consensus about its efficacy in this disorder, and despite the belief that corticosteroid could reduce pulmonary inflammation and fibrosis in severe cases, our poor results suggest that this strategy will need to be carefully reevaluated in the future.