Severe community-acquired pneumonia is the most common cause of acute respiratory distress syndrome (ARDS). Despite multiple improvements in the last 10 years, this syndrome remains highly prevalent worldwide and is associated with high mortality and long-term morbidity rates. Several factors are related to the increasing risk of ARDS. Clinicians should be familiar with the use of lung-protective strategies and the mechanism of ventilator-induced lung injury, as ventilator management of ARDS is complex. Clinical trials are now needed, to investigate adjunctive therapies in patients with severe pneumonia and ARDS, such as systemic corticosteroids.