Acute respiratory distress syndrome (ARDS) is a serious disease with high mortality, which is characterized by non-cardiogenic pulmonary edema and hypoxemia. In recent years, the development of supportive therapy has reduced the mortality to some extent, however, the high cost of treatment, side effects and the high mortality of moderate and severe ARDS limit its efficacy. So it is necessary to strengthen the research on specific drugs. The core pathological changes of ARDS are the uncontrolled inflammatory response and the impairment of pulmonary vascular endothelium and alveolar epithelial barrier function. Therefore, regulating the intensity of inflammatory response and promoting the endothelial and epithelial barrier have become two key factors in the current drug treatment of ARDS. This article summarizes the pathogenesis of ARDS and the related preclinical drug therapy of ARDS in recent years from two aspects: the uncontrolled inflammatory response and the destruction of alveolar epithelial and pulmonary vascular endothelial barrier, in order to provide reference for the later treatment of ARDS.