Background: ARDS, first described in 1967, is a clinical syndrome characterized by an uncontrollable pulmonary inflammation which rapidly can lead to respiratory failure and multiple organ dysfunction and death. Despite 50 years of research, the mortality rate remains as high as 30-60 %. Initial studies using inhaled NO in the treatment of ARDS has led to optimism, believing that the vasodilating, antiinflammtory and antiaggregating properties of iNO can improve the clinical outcome of this syndrome. Objective: To evaluate if iNO should have a role in the management of ARDS in adults. In order to answer this, we have been evaluating the effects of iNO in terms of oxygenation (PaO2/FiO2 ratio) and mortality. Material and methods: We conducted a literature search in the PubMed database, using the key words «respiratory distress syndrome, adult AND nitric oxide» which resulted in 518 articles. We excluded articles that did not meet the following criteria: adult individuals, English grammar and RCTs. We also excluded articles that did not fit our objective. This resulted in 19 articles, which are included in this literature review. Results: iNO improves oxygenation in ARDS patients, although the effect on the PaO2/FiO2 ratio seems to be transient, lasting for only 4-48 hours. None of the RCTs showed a decrease in the mortality rate when treated with iNO. In addition, iNO has been associated with adverse effects, e.g. elevated creatinine levels and an increased need of RRTs. Conclusion: Taking into account a non-persistent improvement in oxygenation, a lack of effect on mortality outcome and the potential damages, we do not recommend iNO as a routine treatment in adult patients with ARDS. However, some patients with acute refractory hypoxemia may benefit from the short-term improvements in oxygenation, i.e. iNO can be used as a rescue therapy.