In this episode, Dr Swapnil Pawar is joined by Dr Ary Serpa Neto to discuss the GUARDS trial, which is testing whether dexamethasone reduces 60-day mortality in patients with moderate to severe ARDS. We cover the rationale for steroids in ARDS, the choice of drug and dose, the expanded eligibility criteria including non-intubated patients, how the sample size was calculated, and the funding and design realities behind running a trial of this scale.