Effect of Sivelestat Sodium Hydrate in Three Patients with Septic ARDS

We administered sivelestat sodium hydrate, a selective polymorphonuclear leukocyte elastase (PMNE) inhibitor, to three patients with septic ARDS. While causing a decrease in the serum PMNE and surfactant protein D levels, the neutroin the serum and BAL PMNE levels and reduced pulmonary function. In the context of these findings, we had previously suggested that surfactant protein D (SPD) might also be involved in the pathogenesis of ARDS, because we had observed high values of this protein in ARDS patients [8,9]. Sivelestat sodium hydrate (sivelestat) is a selective PMNE inhibitor. It has been shown in experimental studies to attenuate pulmonary injury and improve respiratory function. The PMNE inhibitor has also been shown to be effective in the treatment of patients with pulmonary injury associated with SIRS [10-13]. Sivelestat was the first drug to be approved in Japan for the treatment of acute lung injury (ALI) associated with SIRS. In this study, we administered sivelestat to 3 patients with septic ARDS and evaluated the drug’s efficacy in these patients by determining the serum PMNE and SPD levels, as well as the PaO 2/FiO2 (P/F) ratio.