Anti-CD14 Treatment With IC14 in Hospitalized ARDS Patients

Inclusion Criteria

Patients may be included in the study only if they meet all the following criteria:

• Adult patients (18+) on mechanical ventilations with acute respiratory distress syndrome (ARDS) by Berlin Criteria (≤48 hours)

• P:F ratio \< 300
• Positive end-expiratory pressure (PEEP) ≥5 cm H2O
• Bilateral opacities on chest x-ray or chest computerized tomography (CT)-- not fully explained by effusions, lobar/lung collapse, or nodules
• Respiratory failure not fully explained by cardiac failure or fluid overload
• Within 1 week of known clinical insult or new or worsening respiratory symptoms

i. Common Risk Factors for ARDS: Pneumonia, aspiration, inhalation injury, pulmonary contusion, pulmonary vasculitis, drowning, non-pulmonary sepsis, major trauma, pancreatitis, severe burns, non-cardiogenic shock, drug overdose, multiple transfusions

• Patient or Legal authorized representative able to understand and give written informed consent

Exclusion Criteria

An individual fulfilling any of the following criteria should be excluded from enrollment in the study:

• Significant pre-existing organ dysfunction prior to hospitalization

• Lung: Currently receiving home oxygen therapy as documented in medical record
• Heart: Pre-existing congestive heart failure defined as an ejection fraction \<20% as documented in the medical record
• Renal: End-stage renal disease requiring renal replacement therapy or estimated glomerular filtration rate (eGFR) \<30 mL/min.
• Liver: Severe chronic liver disease defined as Child-Pugh Class C or hepatic transaminases >5 times upper limit of normal
• Hematologic: Baseline platelet count \<50,000/mm3
• Presence of co-existing infection, including, but not limited to:

• HIV infection not virally suppressed and with pre-hospitalization CD4 counts ≤ 500 cell/mm3
• Active tuberculosis or a history of inadequately treated tuberculosis
• Active hepatitis B or hepatitis C viral infection
• Current treatment, or treatment within 30 days or five half-lives (whichever is longer) with etanercept (Enbrel®), infliximab (Remicade®), adalimumab (Humira®), certolizumab (Cimzia®), golimumab (Simponi®), anakinra (Kineret®), rilonacept (Arcalyst®), tocilizumab (Actemra®), sarilumab (Kevzara®), siltuximab (Sylvant®), or other potent immunosuppressant or immunomodulatory drugs or treatments
• Receiving comfort measures only
• Requiring >2 vasopressors
• Pregnant
• Prisoners
• History of hypersensitivity or idiosyncratic reaction to IC14
• Women who are currently breastfeeding
• Bronchoscopy safety exclusions

• P:F \<100 on 100% FiO2
• Mean pulmonary artery pressure > 55 mmHg
• Marked cardiovascular instability (Mean arterial pressure \<55 mmHg with vasopressor support)
• Intracranial pressure ≥20 mmHg
• Acute ischemic heart disease (unstable angina or ST-elevation myocardial infarction or Type 1 non-ST-elevation myocardial infarction)
• Supported on extracorporeal membrane oxygenation
• Endotracheal tube \<6.5 mm