Severe acute pancreatitis (SAP) is a common acute abdominal disease in clinical practice. It is caused by abnormal activation of pancreatic enzymes, which results in digestion of the pancreas itself and surrounding organs, mainly represented by local inflammatory reaction of the pancreas, and even leads to organ dysfunction. SAP is often complicated by acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), which is one of the major causes for high mortality of SAP. The incidence of SAP-associated ALI ranges from 15% to 55%, and its clinical manifestations vary from mild hypoxemia to ARDS. In addition, ALI/ARDS is the most significant manifestation of extra-abdominal organ dysfunction of SAP, with a mortality rate up to 60% within the first week of onset. In recent years, many studies have found that SAP-associated ALI is inextricably linked to the activation of a variety of signaling pathways, and yet, on the other hand, the stimulation of various inflammatory factors, oxidative stress and cell apoptosis are also the important causes responsible for SAP-associated ALI. Here, the authors address the latest research progress on the mechanism of SAP-associated ALI and the treatment.