Role of Vascular Endothelial Growth Factor (VEGF) in Acute Lung Injury/Adult Respiratory Distress Syndrome (ARDS)

In previous lab experiments, we observed evidence of pulmonary edema following alveolar
epithelial overexpression of VEGF, suggesting a potential role for VEGF in ARDS. In
addition, we found that preventing VEGF from reaching its target receptor(s) by
overexpressing a soluble form of a VEGF receptor protein prevents edema formation.

These observations heighten the plausibility of VEGF playing an important role in the
development of increased pulmonary capillary permeability during acute lung injury.
Understanding this role VEGF plays in ARDS consequently provides an ideal opportunity to
discover new therapies for ARDS.

Inclusion Criteria:

1. Patients that meet the American-European Consensus Conference criteria for ARDS [(1)
Widespread pulmonary infiltrates; (2) Pulmonary capillary wedge pressure 18 mmHg; (3)
PaOz/FiO; ratio 200; (4) compatible history], or acute lung injury [same as ARDS, but
PaOz/FiOz ratio 300], or are at increased risk for developing acute lung injury
because of sepsis, pancreatitis, trauma, acid aspiration, radiation or
chemotherapy-induced lung toxicity, and near drowning. Pulmonary edema is divided
into two broad categories: hydrostatic or cardiogenic and increased-permeability or
noncardiogenic edema12. Since ARDS is noncardiogenic in origin, patients with
pulmonary edema due to congestive heart failure will serve as a control group.

2. Inpatients that are endotracheally intubated.

3. Patients that are able to provide informed consent or informed consent is granted by
a family member or legal health care proxy.

4. Males or females that are 18 years or older.

Exclusion Criteria:

- Individuals who are too hypoxemic for bronchoscopy to be performed safely. Patients
requiring V\0z > 0.7 and/or PEEP 15 will be excluded.

2. If the patient will be unable to tolerate bronchoscopy because of severe

acidosis, tension pneumothorax, active bronchospasm, hemodynamically significant cardiac
arrhythmia, or intractable shock as defined as the inability to maintain a mean arterial
pressure 60 mmHg or severe uncorrectable bleeding diathesis (tendency) or as otherwise
determined by the pulmonary physician.

3. Females who are pregnant will not be accepted into the study. 4. Patients with recent
(48 hours) acute myocardial infraction will not be accepted into the study.

5. Patients with a history of adverse reactions to lidocaine will be not be accepted into
the study. 6. Patients who lack capacity to give informed consent due to acute panic
attack, "intensive care unit" psychosis or other psychologic dysfunction.