Fig. 1

Proposed cascade of events leading to angiotensin II insufficiency. The figure outlines a cascade of events that could occur amongst patients with inflammation and/or lung injury. When acute lung injury is significantly complicated by pulmonary endothelial injury, ACE activity is diminished [11]. Thus, patients who lose ACE activity may be a risk for angiotensin II insufficiency and catecholamine resistance [12]. ACE angiotensin-converting enzyme, ARDS acute respiratory distress syndrome, PCE pulmonary capillary endothelium