• Kenji Tsushima, Toshiki Yokoyama, Takuya Matsumura, Tomonobu Koizumi, Keishi Kubo, Koichiro Tatsumi, and Acute Lung Injury Group in Nagano.
• 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.
• J Crit Care. 2014 Jun 1;29(3):420-5.

PurposeNoninvasive 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.MethodsARDS-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.ResultsA 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.ConclusionsAdministration of neutrophil elastase inhibitor with NIV may be associated with successful outcome in mild-to-moderate ARDS-patients with initial PaO2/FiO2>150.Copyright © 2014 Elsevier Inc. All rights reserved.

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