Abstract: OBJECTIVE To explore the clinical characteristics of severe pneumonia complicated with severe acute respiratory distress syndrome (ARDS) in respiratory intensive care unit (RICU) and analyze the influencing factors for prognosis so as to provide guidance for clinical diagnosis and treatment of the viral pneumonia. METHODS A total of 160 severe pneumonia patients complicated with severe ARDS who were treated in the RICU from Jan 2012 to Aug 2014 were enrolled in the study, then the clinical data of the patients were retrospectively analyzed, the patients were divided into the death group with 109 cases and the survival group with 51 cases according to the status of prognosis, the distribution of pathogens was investigated, the clinical characteristics of the severe pneumonia complicated with severe ARDS were observed, the influencing factors for the prognosis were analyzed, and the statistical analysis was performed with the use of SPSS 17.0 software. RESULTS Of 160 severe pneumonia patients complicated with ARDS, 109 died, with the mortality rate 68.13%. The etiological analysis showed that 25 patients were tested positive for H1N1, 9 patients tested positive for Coxsackie virus, 8 patients tested positive for cytomegalovirus. Totally 39 patients had bacterial infections, 23 patients had secondary fungal infections, and 16 patients had mixed fungal infections. The average age of the death group was significantly higher than that of the survival group (t=5.27,P＜0.05). The length of RICU stay and mechanical ventilation duration were significantly shorter in the death group than in the survival group (t=12.36、8.95,P＜0.05). The oxygenation index of the death group was significantly lower than that of the survical group (t=4.37,P＜0.05). CONCLUSION The mortality rate of the severe pneumonia patients complicated with severe ARDS is high in the RICU. The prognosis is associated with the average age, length of RICU stay, mechanical ventilation duration, and oxygenation index.