Usefulness of a selective neutrophil elastase inhibitor (sivelestat) in septic ARDS patients after gastrointestinal surgery.
OBJECTIVE
The usefulness of a neutrophil elastase inhibitor (sivelestat) was evaluated for treating septic acute respiratory distress syndrome (ARDS) after gastrointestinal surgery.


METHODS
The subjects were 36 patients with septic ARDS after gastrointestinal surgery. ARDS was defined as acute lung injury associated with systemic inflammatory response syndrome. Sivelestat was intravenously administered at a dose of 0.2 mg/kg/hr continuously for 3 days or more. The effectiveness of sivelestat was evaluated based on the lung injury score, P/F ratio, and ventilator free days (VFD).


RESULTS
Marked responses were observed in 12 patients (33.3%), responses in 17 (47.2%), and no response in 7 (19.4%). In the patients with marked responses or responses (responders), the P/F ratio was significantly improved on day 3 of drug administration and at the end of administration compared with the pre-administration ratio. Comparison between the responders and non-responders showed significant differences on day 3 and at the end of drug administration. VFD significantly differed between the responders (18.8 days) and the non-responders (11.0 days).


CONCLUSIONS
In conclusion, sivelestat may be effective against septic ARDS. The effectiveness of the drug could be determined based on improvement in oxygenation ability on day 3 of drug administration.
Togo
Shinji
S
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. togo@med.yokohama-cu.ac.jp
Matsuo
Kenichi
K
Ishibe
Atsushi
A
Nagano
Yasuhiko
Y
Takahashi
Masazumi
M
Mochizuki
Hirohiko
H
Osada
Shunichi
S
Kameda
Kunio
K
Shimada
Hiroshi
H
D055371:Acute Lung Injury / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000368:Aged; D003422:Critical Care; D004334:Drug Administration Schedule; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D005998:Glycine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D019272:Leukocyte Elastase / Q000037:antagonists & inhibitors*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000209:etiology; D018805:Sepsis / Q000188:drug therapy*; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy* / Q000209:etiology
D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; C069195:sivelestat; D019272:Leukocyte Elastase; D010100:Oxygen; D005998:Glycine