To determine whether acute respiratory distress syndrome (ARDS) complicating bacteremic sepsis independently affects mortality in critically ill patients, we conducted a 3-year retrospective cohort study in a surgical intensive care unit. We included all consecutive patients with blood culture-positive sepsis and measured organ dysfunctions and mortality. Among 4,530 admissions, 196 cases of bacteremic sepsis were recorded. ARDS occurred in 31 (16%) of these patients. The case-fatality rate was 58% in patients with ARDS, compared to 31% in patients without ARDS. Using Cox proportional hazards regression with time-dependent variables, the unadjusted hazard ratio for death was 1.8 (95% confidence interval [CI], 1.0 - 3.2). After adjusting for comorbid factors present before onset of sepsis, the hazard ratio was 2.2 (95% CI; 1.2 - 3.9). After further adjustment was made for non-pulmonary organ dysfunctions and microbiologic factors that were independently associated with mortality, the adjusted hazard ratio for ARDS was 0.6 (95% CI; 0.3 - 1.2). Among critically ill surgical patients, ARDS complicating bacteremic sepsis remains common, but it is not independently associated with short-term mortality, after adjusting for severity of illness and non-pulmonary organ dysfunctions evolving after onset of sepsis.