Acute respiratory distress syndrome (ARDS) associated with A(H5N1) avian influenza virus infection develops severe ARDS, and also other types of influenza among children. It is an urgent mission to elucidate the mechanism of influenza-associated ARDS and to develop a therapeutic strategy. For this purpose, we have been co-operating the prospective study for severe ARDS with National Hospital of Pediatrics–Hanoi (NHP-Hanoi) from October 2007. During 2007/10 to 2013/03, 102 patients were diagnosed as severe ARDS matched in the criteria of prospective study. Among them, influenza viruses were detected from tracheal lavage fluid and/or nasopharyngeal aspirate (NPA/TLF) samples with PCR in 8 cases; A(H5N1), A(H1N1)pdm09, A(H3N2). These 8 cases and 9 cases of severe ARDS with A(H5N1) infection before 2007/10 were considered as influenza group together. During 2007/10 to 2013/03, other viruses were detected in 22 severe ARDS cases (not-influenza group): CMV, HRV, ADV, RSV and Measles. When the clin- ical data were analyzed in 17 influenza group and 22 not- influenza group respectively, significant differences were observed in pH and PaCO2 in arterial blood gas analysis (ABGA) and also AST/ALT values, white blood cells and platelets counts in the serum. Survival probability analysis showed the significant differences between the groups (p=0.0023 by log-lank test, p=0.0013 by Wilcoxon test) resulting longer survival days in not-influenza group. In addition, intravenous immunoglobulin infusion (IVIG) treatment showed difference in survival profile of patients especially in influenza-associated ARDS, suggesting that the IVIG therapy may be effective against severe ARDS with pneumonia. Our results will provide the crucial clinical in- formation.