Hemodynamics and Extravascular Lung Water in Acute Lung Injury

Inclusion Criteria

Acute onset of:

• PaO2/FiO2 less than or equal to 300.
• Bilateral infiltrates consistent with pulmonary edema on the frontal chest radiograph.
• Requirement for positive pressure ventilation through an endotracheal tube or tracheostomy.
• No clinical evidence of left atrial hypertension that would explain the pulmonary infiltrates. If measured, pulmonary arterial wedge pressure less than or equal to 18 mmHg.

Exclusion Criteria

• Age younger than 18 years old.
• Greater than 24 hours since all inclusion criteria first met.
• Neuromuscular disease that impairs ability to ventilate without assistance, such as C5 or higher spinal cord injury, amyotrophic lateral sclerosis, Guillain-Barré syndrome, myasthenia gravis, or kyphoscoliosis (see Appendix I.A).
• Pregnancy (negative pregnancy test required for women of child-bearing potential).
• Severe chronic respiratory disease (see Appendix I.C).
• Severe Chronic Liver Disease (Child-Pugh 11 - 15, see Appendix I.E)
• Weight > 160 kg.
• Burns greater than 70% total body surface area.
• Malignancy or other irreversible disease or conditions for which 6-month mortality is estimated to be greater than 50 % (see Appendix I.A).
• Known cardiac or vascular aneurysm.
• Contraindications to femoral arterial puncture - platelets 3.0.
• Not committed to full support.
• Participation in other experimental medication trial within 30 days.
• Allergy to intravenous lasix or any components of its carrier.
• History of severe CHF - NYHA class ≥ III, previously documented EF < 30%.
• Diffuse alveolar hemorrhage.
• Presence of reactive airway disease (active will be defined based on recent frequency and amounts of MDI's use and steroids to control the disease).