title: The potential efficacy of noninvasive ventilation with administration of a neutrophil elastase inhibitor for acute respiratory distress syndrome.
abstract: OBJECTIVE
  Noninvasive ventilation (NIV) can reduce the need for invasive mechanical ventilation. The aim of this investigation was to determine whether the combination of NIV with administration of a neutrophil elastase inhibitor could improve outcome and respiratory conditions in acute respiratory distress syndrome (ARDS)-patients, according to the Berlin definition.
  
  
  METHODS
  ARDS-patients were treated with NIV and a neutrophil elastase inhibitor. Patients were classified as having mild, moderate, and severe ARDS. ARDS-patients were divided into survivors and nonsurvivors on day 28 after the induction of NIV.
  
  
  RESULTS
  A total of 47 ARDS-patients received NIV, and 37 of these patients did not require endotracheal intubation. Eight mild, 17 moderate, and 10 severe ARDS-patients were alive on day 28 after the induction of NIV. When ARDS-patients were divided into groups based upon an initial PaO2/FiO2 greater or less than 150 torr, the serial changes of both the PaO2/FiO2 and the lung injury score improved dramatically in those patients with a PaO2/FiO2>150. The survival ratio showed statistically significant differences in mild and moderate ARDS-patients treated with the neutrophil elastase inhibitor.
  
  
  CONCLUSIONS
  Administration of neutrophil elastase inhibitor with NIV may be associated with successful outcome in mild-to-moderate ARDS-patients with initial PaO2/FiO2>150.
authors.affiliation: First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto Nagano 390-8621 Japan; Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku Chiba 260-8670 Japan. Electronic address: tsushimakenji@yahoo.co.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsushima
authors.affiliation: First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto Nagano 390-8621 Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yokoyama
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku Chiba 260-8670 Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Matsumura
authors.affiliation: First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto Nagano 390-8621 Japan.
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Koizumi
authors.affiliation: First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto Nagano 390-8621 Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Kubo
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku Chiba 260-8670 Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tatsumi
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D055370:Lung Injury / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000401:mortality; D053491:Proteinase Inhibitory Proteins, Secretory / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D053491:Proteinase Inhibitory Proteins, Secretory
keywords: Acute respiratory distress syndrome; Berlin definition; Neutrophil elastase inhibitor; Noninvasive ventilation; Pao(2)/Fio(2)