The APS Phenotyping Study

Eligibility Criteria

• 1. Age ≥ 18 years old
• 2. Admitted (or planned to be admitted) to an intensive care unit (ICU) or other in-patient hospital location where IV vasopressors or advanced respiratory support (invasive mechanical ventilation, non-invasive ventilation, or high flow nasal cannula) are routinely provided (referred to as an "eligible unit.")
• 3. Acute cardiovascular or pulmonary organ dysfunction defined by meeting at least one of the two criteria below:
• * New receipt of invasive mechanical ventilation, non-invasive ventilation, high flow nasal cannula, or supplemental oxygen at a flow rate of ≥ 6 lpm for acute hypoxemia.
• * Receipt of intravenous infusion of a vasopressor medication for at least one hour.
• 4. Acute cardiovascular or pulmonary organ dysfunction (inclusion criterion #3) is attributed to an acute inflammatory condition, including but not limited to any of the following:
• * Any infection including pneumonia.
• * Aspiration pneumonitis.
• * Pancreatitis.
• * Auto-inflammatory condition such as:
• 1. Hemophagocytic lymphohistiocytosis.
• 2. Suspected acute rheumatologic or auto-immune disease with pulmonary or cardiovascular manifestations.
• 3. Suspected cryptogenic organizing pneumonia presenting acutely.
• 4. Suspected diffuse alveolar hemorrhage.
• 5. Suspected acute anaphylaxis.
• 6. Suspected acute pulmonary drug toxicity.
• 1. Patient/legally authorized representative (LAR) declines participation.
• 2. Acute cardiovascular or pulmonary organ dysfunction (inclusion criterion #3) has been present for \> 48 hours.
• 3. Patient has been in an eligible unit (inclusion criterion #2) for more than 120 hours (five days).
• 4. Patient is no longer expected to meet the acute cardiovascular or pulmonary organ dysfunction inclusion criterion (inclusion criterion #3) 24 hours after enrollment.
• 5. Patient desires comfort measures only.
• 6. Patient is a prisoner.
• 7. Patient had out-of-hospital cardiac arrest leading to this hospitalization.
• 8. Residence immediately before this hospitalization in a long-term acute care facility.
• 9. Presence of tracheostomy for respiratory failure.
• 10. Home invasive mechanical ventilation or non-invasive ventilation (except patients with non-invasive ventilation prescribed as a treatment for a sleep disorder may participate).
• 11. Suspected cause of the patient's acute cardiovascular and/or pulmonary dysfunction (inclusion criterion #3) is an alternative condition (not ARDS, pneumonia, or sepsis), including but not limited to the list below:
• * Drug overdose (without aspiration, lung injury, pneumonia, or infection).
• * Trauma (without aspiration, pneumonia, or infection).
• * Chronic lung disease without suspected infection, aspiration, or inflammation.
• * Asthma, chronic obstructive pulmonary disease (COPD), sarcoidosis, interstitial lung disease, neuromuscular respiratory failure.
• * Status epilepticus.
• * Acute pulmonary embolism.
• * Acute decompensated heart failure.
• * Diabetic ketoacidosis.
• * Acute stroke or intracranial hemorrhage.
• * Acute bleeding (GI bleeding, post-procedural bleeding, hemolysis).
• * Cytokine release syndrome due to chemotherapy.
• 12. Inability or unwillingness to complete study-specified blood draws, for example, due to local policies about hemoglobin thresholds for research blood draws.