Objective To analyze the related factors affecting the prognosis of patients with acute respiratory distress syndrome (ARDS) and the predictive value of severe ultrasound on the prognosis of patients. Methods The clinical data of 124 patients with ARDS admitted to the intensive care unit of our hospital from January 2019 to January 2020 were retrospectively analyzed. All patients underwent active treatment. According to the survival within 28 days of treatment, the patients were divided into survival group and death group, 66 cases and 58 cases respectively. Collect the clinical data of patients on admission and the treatment after admission. Multivariate logistic regression analysis was used to analyze the relevant factors affecting the prognosis of the patients. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of severe ultrasound examination on the prognosis of patients. Results The two groups of patients were significantly different in age, ARDS type, ARDS grade, combined shock, APACHE II score and SOFA score (P<0.05). Old age, ARDS type (intrapulmonary type), combined shock, APACHE II score (15 ~ 25 points), SOFA score (> 6 points) are independent risk factors for patients'' prognosis. The LUS score of the patients in the survival group was significantly lower than that in the death group, while the TAPSE was significantly higher than that in the death group (P<0.05). There was no significant difference in LVEDD, RVEDD, LVEF, RVEF and TAPSE between the two groups of patients (P>0.05). The area under the curve of LUS, TAPSE and the combination of the two is 0.984, 0.900, 1.00, the optimal critical values are 14.175 points, 21.425mm, -1.973, the sensitivity is 96.6%, 95.5%, 100.0%, and specificity, respectively. They are 92.9%, 84.5%, and 100.0%. Conclusion Older age, ARDS type (intrapulmonary type), combined shock, APACHE II score (15-25 points) at admission, and SOFA score (>6 points) at admission are independent risk factors for the prognosis of ARDS patients. At admission, LUS and TAPSE have a high predictive value for the prognosis of ARDS patients, and the joint detection of the two can further improve the predictive value