In regard to management of ARDS with evidence of cytokine release syndrome, several adjunctive therapies have been proposed. The rationale for the use of corticosteroids is to reduce host inflammatory responses in the lungs. The potential harm, such as delayed viral clearance, increased risk of secondary infection, and hyperglycemia episodes, have led to caution in their routine use in COVID-19 patients unless the patient had other conditions for which these are indicated [3,4,18,19,20,21]. However, in observational and randomized studies focused on hospitalized patients with COVID-19 pneumonia, the administration of corticosteroids reduced the risk of mortality [25,26,27]. Based on this fact, a recently published guideline suggested using 40 mg methylprednisolone intravenously for 10 days in patients with severe COVID-19 and ARDS [22]. In our study, corticosteroids were included in 87.7% of the protocols. Methylprednisolone was the most frequently included corticosteroid in the protocols (13/15 protocols) with high-dose regimens (≥1 mg/kg/day) and a variable duration of treatment (between 3 and 10 days). High-dose dexamethasone (20 or 40 mg) was included in 53.3% of the protocols and prednisone in just one protocol (40 mg per day for 5 days). Monoclonal antibodies targeting key inflammatory citokines or other aspects of the innate immune response are another potential treatment for COVID-19 [28]. Tocilizumab, an anti-interleukin 6 receptor antibody, has been used in small studies with early reports of success. A dose of 400 mg was associated with clinical improvements and successful discharge, with most patients only receiving a single dose [29,30]. Several randomized clinical trials on tocilizumab, either alone or in combination, in patients with COVID-19 with severe pneumonia are underway, and its use was included in the Chinese national treatment guidelines [30,31]. Likewise, tocilizumab was recommended in all protocols in Andalusian hospitals; the protocols indicate a single dose of 400 mg or 600 mg, according to body weight, and a second dose 12-24 h later, if required. Although tocilizumab is a promising therapy, the data currently available are still too limited to draw any conclusion about its viability. Anakinra, an interleukin 1 receptor antagonist, has also been proposed in order to reduce hyperinflammation and respiratory distress in patients with SARS-CoV-2 infection, but here, too, limited evidence has been published [32]. In this study, less than half of the protocols included anakinra in their recommendations, and six different regimens were described with significant differences in dosage (ranging from 100 to 400 mg per day) and duration of treatment (between 3 and 10 days). Other monoclonal antibodies, immunomodulatory agents, and immunoglobulin therapy are in clinical trials for the treatment of COVID-19-associated cytokine release syndrome [3].