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A major problem of the techniques used for quantifying endotoxin levels has been their low sensitivity. To address this problem, a diagnostic kit called Endotoxin Activity Assay (EAA^TM) was developed. The degree of lung injury must be determined when formulating treatment strategies for patients with sepsis and prognosticating the outcome of this condition. Based on the observations described above, we hypothesize that endotoxin can serve as an important biomarker in evaluating lung injury. Currently, lung injuries in patients with septic shock or ARDS can be assessed by cardiorespiratory monitoring. One such monitoring system is called Pulse index Continuous Cardiac Output (PiCCO). It measures cardiac output (CO) using a thermodilution technique that employs a cold thermal indicator. It then calculates CO per beat using pulse contour analysis. Importantly, PiCCO can also measure extravascular lung water (EVLW) and the pulmonary vascular permeability index (PVPI) that reflect the severity of lung injury. PVPI was significantly higher in patients with high EAA levels than in those with normal EAA levels (3.55 ± 0.48 vs. 1.99 ± 0.68, p = 0.0029). In addition, the patient group with high PCT levels showed significantly lower cardiac indices than the group with normal PCT levels (3.40 ± 1.05 vs. 4.80 ± 0.39, p = 0.0325). he results described above indicate that the EAA level is closely correlated with the degree of lung injury assessed by the PiCCO monitor. This suggests that EAA could also be used as a valuable tool in monitoring lung injury.