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To study the incidence of acute lung injury or acute respiratory distress syndrome (ALI/ARDS) in patients with subarachnoid hemorrhage (SAH) and to investigate the risk factors for ALL/ARDS occurrence and its impact on patient prognosis. Methods The clinical data of 167 consecutive patients with SAH admitted to the First Hospital of Soochow University from Jan 2018 to Dec 2021 were analyzed retrospectively. Multivariate logistic regression model was used to analyze the risk factors that influence the occurrence of ALI/ARDS and contribute to the poor prognosis of patients. Results Of the 167 patients, 45 developed ALL/ARDS and 49 had a poor prognosis. In multivariate logistic regression analysis, elderly patients, lower glasgow coma scale (GCS), higher Hunt-Hess grade, higher simplified acute physiology score (SAPS) II, gastric aspiration, hypoxemia, and tachypnea were associated with an increased incidence of ALL/ARDS. Meanwhile high Fisher's classification, low GCS score, higher Hunt-Hess grade, duration of mechanical ventilation, and ALI/ARDS were risk factors for poor prognosis. Conclusions Development of ALL/ARDS is a common complication in patients with SAH and is independently associated with poor neurological prognosis. Elderly patients, lower GCS, higher Hunt-Hess grade, higher SAPS II score, aspiration, hypoxemia, and tachypnea were risk factors for ALI/ARDS. [ABSTRACT FROM AUTHOR]