Recommendation: We do not recommend using the following drugs to treat adult patients with ARDS (strength of recommendation “strong recommendation”). GRADE 1B Inhaled/ intravenous β2 stimulant, prostaglandin E1 (PGE1), activated protein C (APC), ketoconazole, and lisofylline (Quality of evidence ”moderate”) GRADE 1C Inhaled nitric oxide (NO) (Quality of evidence ”low”) GRADE 1D Surfactant (Quality of evidence ”very low”) We do not suggest using the following drugs to treat adult patients with ARDS (strength of recommendation “weak recommendation”). GRADE 2B granulocyte macrophage colony-stimulating factor (GM-CSF), N-acetylcysteine (NAC) (Quality of evidence ”moderate”) GRADE 2C Statin (Quality of evidence ”low”)

●Supplementary conditions: These drugs are not approved for clinical use by the Japanese national health insurance system.