Aims & Objectives: High Driving Pressure (the ratio of tidal volume to respiratory system compliance, DP) has been associated with poor outcomes in pediatric acute respiratory distress syndrome (PARDS). We assessed the association between DP levels and time after start mechanical ventilation and outcomes in critically ill children. Methods: This was an observational, prospective study conducted in 12 intensive care units in Bogotá, Colombia, between February 2018 and December 2022. Patients aged 1 month to 18 years with moderate to severe PARDS requiring mechanical ventilation were included. The primary outcome was the level of DP associated with outcomes, assessed at 24, 48, and 72 hours after admission.Results: 184 patients were included with a median age of 11 months (IQR 3–24 months). 70.2% had pulmonary PARDS. A DP greater than 15 cm H2O at 72 hours had the best predictive capacity (AUC 0.83, 95% CI 0.74-0.89) and was associated with an increased risk of mortality (HR 2.51, 95% CI 1.07-5.92; p=0.03), as well as a longer duration of mechanical ventilation (10 days, IQR 7-14 days, vs. 7 days, IQR 5-10 days, p=0.02). A DP less than 15 cm H2O at 72 hours was associated with a reduced risk of requiring high-frequency ventilation support (aOR 0.75, 95% CI 0.67-0.86; p<0.01), regardless of severity, age, and vasopressor support. Conclusions: In children with moderate to severe ARDS, a DP greater than 15 cm H2O 72 hours after the initiation of mechanical ventilation is associated with higher odds of 28-day mortality and a longer duration of mechanical ventilation. Keywords: PEEP, PSDRA, respiratoy failure, Children, driving pressure