The potential efficacy of noninvasive ventilation with administration of a neutrophil elastase inhibitor for acute respiratory distress syndrome

Abstract

Purpose: 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.

Keywords: Acute respiratory distress syndrome; Berlin definition; Neutrophil elastase inhibitor; Noninvasive ventilation; Pao(2)/Fio(2).