Abstract: Acute respiratory distress syndrome (ARDS) was destined to have an extraordinary life at the beginning of its birth, because ARDS not only originated from a new concept, but also brought the misunderstandings in clinical treatment. From pre-diseases to the real causes, from the ventilator as the main therapeutic method to becoming an important etiology, from focusing on ventilation function to disregarding pulmonary blood flow, from isolated lung disease to other organ injuries as the common components, and so on, physicians have to look back on these detours but not simply to repeat these mistakes again, and effectively to identify the road ahead.