Background Acute respiratory distress syndrome (ARDS) is a therapeutic challenge in pediatric intensive care in view of the high mortality.In 1992 about 50 German paediatric hospitals founded a working group aiming on collaborative clinical research in this field.Aim and methods The aim of both a prospective and retrospective survey conducted in German pediatric intensive care units in 1993 was to accumulate data on the epidemiology, risk factors, natural history and treatment strategies in a large group of pediatric ARDS patients who were treated in the three year period from 1991 to 1993.All patients had acute bilateral alveolar infiltration of noncardiogenic origin and a pO2/FiO2 ratio < 150mmHg.The influence of sex, underlying disease and single organ failure was analyzed using the Fischer's exact test, the influence of additional organ failure on mortality was tested with the Cochran-Mantel-Haenszel statistics.Results 112 patients were reported giving an incidence of 7 cases per 1000 admissions to pediatric ICUs.Median age was 24 month.In 43% of the cases, ARDS was associated with a pulmonary, in 39% with a systemic underlying disease.In 20% immunocompetence was impaired.Mortality was 46% and not dependent on age, sex and triggering event.The number of associated organ failures, however, strongly influenced mortality.Mortality in immuno-compromised patients was 81%.The Analysis of treatment modalities employed in the patients revealed a lack of uniform therapeutic strategies.On the other hand, the patients were exposed to interventions not yet supported by controlled trials.Conclusions The observation of the lack of uniform treatment strategies led to the elaboration of recommendations on ventilator therapy and patient monitoring within the working group.The data gathered in this survey provide the basis for the design of prospective multicenter studies urgently needed to evaluate innovative treatment modalities in pediatric ARDS.