Purpose : Pulmonary ultrasound can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often-subjective classification of abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, scoring system that would allow for standardized documentation, have high inter-provider agreement, and correlate with clinical metrics.Methods : rospective of adults intubated for ARF performed at intubation, 48-hours, and extubation. A total lung score (TLS) was calculated. Clinical metrics and final diagnosis were extracted from the medical record.Results : TLS correlated positively with mortality (p=0.0), ventilator hours (p0.00), intensive care unit and hospital length of stay (p=0.00, p=0.0), and decreasing PaO2/FiO2 (p0.00). Agreement of findings was very good (kappa=0.83). Baseline TLS differed significantly between ARF categories (non-pulmonary, obstructive, and parenchymal disease).Conclusions : A quick, was associated with clinical metrics including mortality among a diverse population of patients intubated for ARF. In addition to diagnostic and prognostic information at the bedside, a standardized and quantifiable approach to PU provides objectivity in serial assessment and may enhance communication of findings between providers.