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Rationale: Despite the recognition that acute lung injury (ALI) can elevate pulmonary artery (PA) pressure and right ventricular afterload, the impact of pulmonary vascular dysfunction on outcomes of these patients is not well defined.

Objectives: To investigate the impact of pulmonary vascular dysfunction in patients with acute lung injury.

Methods: Secondary analysis of the Fluid and Catheter Treatment Trial. A total of 501 patients who received a PA catheter were evaluated for associations between increases in transpulmonary gradient (TPG) (PA mean pressure − PA occlusion pressure) or pulmonary vascular resistance index (PVRi) and 60-day mortality, ventilator-, intensive care unit (ICU)–, and cardiovascular-free days (days with mean arterial pressure ≥ 60 mm Hg off vasopressor support).

Measurements and Main Results: We were able to measure the TPG in 475 (95%) and the PVRi in 470 (92%) patients …