Hemodynamics and Extravascular Lung Water in Acute Lung Injury

Inclusion Criteria

• •Acute onset of:
• •1. PaO2/FiO2 less than or equal to 300.
• •2. Bilateral infiltrates consistent with pulmonary edema on the frontal chest radiograph.
• •3. Requirement for positive pressure ventilation through an endotracheal tube or tracheostomy.
• •4. 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.
• •3. 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).
• •4. Pregnancy (negative pregnancy test required for women of child-bearing potential).
• •5. Severe chronic respiratory disease (see Appendix I.C).
• •6. Severe Chronic Liver Disease (Child-Pugh 11 - 15, see Appendix I.E)
• •7. Weight \> 160 kg.
• •8. Burns greater than 70% total body surface area.
• •9. Malignancy or other irreversible disease or conditions for which 6-month mortality is estimated to be greater than 50 % (see Appendix I.A).
• •10. Known cardiac or vascular aneurysm.
• •11. Contraindications to femoral arterial puncture - platelets \< 30, bilateral femoral arterial grafts, INR \> 3.0.
• •12. Not committed to full support.
• •13. Participation in other experimental medication trial within 30 days.
• •14. Allergy to intravenous lasix or any components of its carrier.
• •15. History of severe CHF - NYHA class ≥ III, previously documented EF \< 30%.
• •16. Diffuse alveolar hemorrhage.
• •17. 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).