In present brief review we discussed the underlying reasons for the negative results of international clinical trials in the field of Critical Care Medicine. Since there is a huge heterogeneity among the patients with sepsis or acute respiratory distress syndrome (ARDS) who are recruited in the studies, it is resonable that none of strategy could be fit to all condition no matter medical resource distribution and geographic location. Therefore, it becomes to be nightmare for the researchers as the primary outcome, mortality, is hard to be improved. Only when realizing and resloving above situation, especially the disadvantage of definition of Sepsis and ARDS, could the future large trial be successful.