Background: Acute respiratory distress syndrome (ARDS) is a common clinical syndrome of acute respiratory failure as a result of diffuse lung inflammation and oedema manifested by hypoxemia and stiffness in the lungs. This study aimed to assess the efficacy of each of nebulized hypertonic saline and nebulized budesonide in improving respiratory mechanics, hypoxic index (PaO2/ FiO2), LIS (Murray score), mortality, duration of intensive care unit, and mechanical ventilation days in acute respiratory distress syndrome patients. Methods: This randomized, double-blind, placebo-controlled study was conducted on 90 patients with ARDS. Patients were randomly assigned into 3 equal groups: group I: received standard ICU ARDS care and nebulized hypertonic saline 3% (5ml) /12hr, Group II: received standard ICU ARDS care and nebulized corticosteroids/12hr and Group III: received standard ICU ARDS care and normal saline 0.9% (5ml) nebulizer /12hr as a placebo. Results: Regarding the outcome, ICU stay and MV duration were significantly shorter in group II compared to group I and III (P