Aspiration pneumonitis is a neutrophil mediated inflammatory pneumonitis following the aspiration of regurgitated gastric contents. This syndrome occurs most commonly in patients with depressed levels of consciousness such as drug overdose, seizures, and during anesthesia. Aspiration pneumonitis is the most common cause of anesthesia-related deaths. Aspiration pneumonitis may be clinically silent or present as severe acute lung injury (ARDS) progressing to death. The treatment of acid aspiration pneumonitis is largely supportive. We present two cases of severe life threatening ARDS due to acid aspiration who were treated with the combination of hydrocortisone, ascorbic acid, and thiamine (HAT) and made a dramatic recovery. This treatment strategy should be considered in the management of patients with aspiration pneumonitis.