title: [A case of idiopathic ARDS treated by sivelestat sodium and fluid management based on extravascular lung water index].
abstract: A 65-year-old woman was given emergency admission with fever, cough and dyspnea. Chest computed tomography (CT) findings showed bilateral ground-glass opacity, consolidation, and this case were fulfilled the criteria for acute respiratory distress syndrome (ARDS). We clinically diagnosed the patient as suffering from idiopathic ARDS including acute interstitial pneumonia (AIP) based on the absence of any known causes of ARDS and systemic immunologic diseases. We started treatment with sivelestat sodium and strictly managed fluid balance under mechanical ventilation. We found this treatment quite effective because there were significant improvements in the extravascular lung water index (EVLWI) measured by the PiCCO system and neutrophile elastase value and in oxygenation and the chest radiograph. This is apparently the first case report in the literature that clearly shows the treatment with sivelestat sodium and strict fluid management ended in a favorable outcome, as reducing EVLWI measured by the PiCCO system in an idiopathic ARDS patient.
authors.affiliation: Emergency and Critical Care Medical Center, Osaka City General Hospital.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Rinka
authors.forename: Arito
authors.initials: A
authors.lastname: Kaji
mesh_terms: D000368:Aged; D015633:Extravascular Lung Water / Q000378:metabolism*; D005260:Female; D005440:Fluid Therapy; D005998:Glycine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D019272:Leukocyte Elastase / Q000037:antagonists & inhibitors*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*
chemical_list: D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; C069195:sivelestat; D019272:Leukocyte Elastase; D005998:Glycine