Clinical manifestation of ARDS included tachypnea (100%), chest indrawing / retraction (100%), cyanosis (75%), sterno-cleido-mastoid muscle using (29.2%), nasal flare (54.2%), SpO2 < 92% (91.6%), hypoxemia with mean PaO2: 58.4 ± 6.6 mmHg, mean PaO2/FiO2 115.2 ± 24.6.