Clinical course of patients with ALI/ARDS treated with sivelestat: comparison of effects on direct and indirect lung injury using high-resolution CT and clinical parameters
Objective: Patients with acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) accompanied with sepsis were divided into groups with direct and indirect lung injuries. Clinical courses after administration of sivelestat, a selective neutrophil elastase inhibitor, were compared using h...
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| Published in | Nihon Kyukyu Igakukai Zasshi Vol. 24; no. 1; pp. 19 - 29 |
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| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Association for Acute Medicine
15.01.2013
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0915-924X 1883-3772 |
| DOI | 10.3893/jjaam.24.19 |
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| Abstract | Objective: Patients with acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) accompanied with sepsis were divided into groups with direct and indirect lung injuries. Clinical courses after administration of sivelestat, a selective neutrophil elastase inhibitor, were compared using high-resolution CT (HRCT). Subjects and Methods: The subjects were 20 patients with ALI/ARDS who received HRCT at seven medical emergency care centers in Kanagawa Prefecture from January 2006 to March 2008, and in whom continuous intravenous administration of sivelestat hydrate at a dose of 0.2 mg/kg/hr for 5 days or more was started upon diagnosis. Changes of lung oxygenation and chest X-ray and HRCT findings were evaluated. HRCT findings for consolidation, ground-glass opacity, thickening of the interlobular septum, and traction bronchiectasis were scored, and the clinical courses of patients with direct lung injury (ALI/ARDS due to severe pneumonia) and indirect lung injury (ALI/ARDS due to other infections) were compared to evaluate the effects of sivelestat. Result: The rates of improvement of lung oxygenation in the direct (n=10) and indirect (n=10) lung injury groups were 60% and 100%, respectively, with a tendency for greater efficacy of sivelestat for indirect lung injury. There were no differences in chest X-ray scores, but the “acute-phase” HRCT score (total of the consolidation and ground-glass opacity scores) showed greater improvement in the indirect lung injury group, with strong correspondence to the change in lung oxygenation. Conclusion: Clinical courses in subjects receiving sivelestat were better in those with indirect lung injury compared to cases with direct lung injury. HRCT was found to be useful for determining the pathological stage of ALI/ARDS and the appropriate timing of drug administration. |
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| AbstractList | Objective: Patients with acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) accompanied with sepsis were divided into groups with direct and indirect lung injuries. Clinical courses after administration of sivelestat, a selective neutrophil elastase inhibitor, were compared using high-resolution CT (HRCT). Subjects and Methods: The subjects were 20 patients with ALI/ARDS who received HRCT at seven medical emergency care centers in Kanagawa Prefecture from January 2006 to March 2008, and in whom continuous intravenous administration of sivelestat hydrate at a dose of 0.2 mg/kg/hr for 5 days or more was started upon diagnosis. Changes of lung oxygenation and chest X-ray and HRCT findings were evaluated. HRCT findings for consolidation, ground-glass opacity, thickening of the interlobular septum, and traction bronchiectasis were scored, and the clinical courses of patients with direct lung injury (ALI/ARDS due to severe pneumonia) and indirect lung injury (ALI/ARDS due to other infections) were compared to evaluate the effects of sivelestat. Result: The rates of improvement of lung oxygenation in the direct (n=10) and indirect (n=10) lung injury groups were 60% and 100%, respectively, with a tendency for greater efficacy of sivelestat for indirect lung injury. There were no differences in chest X-ray scores, but the “acute-phase” HRCT score (total of the consolidation and ground-glass opacity scores) showed greater improvement in the indirect lung injury group, with strong correspondence to the change in lung oxygenation. Conclusion: Clinical courses in subjects receiving sivelestat were better in those with indirect lung injury compared to cases with direct lung injury. HRCT was found to be useful for determining the pathological stage of ALI/ARDS and the appropriate timing of drug administration. |
| Author | Unemoto, Kyoko Niimi, Hiroshi Nishimaki, Horoshi Imai, Hiroshi Nakazawa, Akio Seki, Ippei Arata, Shinju Sugiyama, Mitsugi Inokuchi, Sadaki Kurokawa, Akira Sasaki, Jun Nakagawa, Yoshihide Soma, Kazui Narihara, Kentaro |
| Author_xml | – sequence: 1 fullname: Nakagawa, Yoshihide organization: Tokai University Hospital – sequence: 1 fullname: Sugiyama, Mitsugi organization: Yokohama City University Medical Center – sequence: 1 fullname: Inokuchi, Sadaki organization: Tokai University Hospital – sequence: 1 fullname: Arata, Shinju organization: Yokohama City University Medical Center – sequence: 1 fullname: Niimi, Hiroshi organization: St. Marianna University School of Medicine Hospital – sequence: 1 fullname: Seki, Ippei organization: St. Marianna University School of Medicine Hospital – sequence: 1 fullname: Unemoto, Kyoko organization: Nippon Medical School Musashi Kosugi Hospital – sequence: 1 fullname: Nishimaki, Horoshi organization: St. Marianna University School of Medicine Hospital – sequence: 1 fullname: Soma, Kazui organization: Kitasato University Hospital – sequence: 1 fullname: Nakazawa, Akio organization: St. Marianna University School of Medicine Yokohama-shi Seibu Hospital – sequence: 1 fullname: Imai, Hiroshi organization: Kitasato University Hospital – sequence: 1 fullname: Kurokawa, Akira organization: Nippon Medical School Musashi Kosugi Hospital – sequence: 1 fullname: Sasaki, Jun organization: Showa University Fujigaoka Hospital – sequence: 1 fullname: Narihara, Kentaro organization: Showa University Fujigaoka Hospital |
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| References | 1) Bernard GR, Artigas A, Brigham KL, et al: The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994; 149: 818-24. 13) ARDS network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000; 342: 1301-8. 4) Ichikado K, Johkoh T, Ikezoe J, et al: Acute interstitial pneumonia: high-resolution CT findings correlated with pathology. AJR Am J Roentgenol. 1997; 168: 333-8. 7) Tomashefski JF Jr: Pulmonary pathology of acute respiratory distress syndrome. Clin Chest Med. 2000; 21: 435-66. 10) Tamakuma S, Ogawa M, Aikawa N, et al: Relationship between neutrophil elastase and acute lung injury in humans. Pulm Pharmacol Ther. 2004; 17: 271-9. 3) Pratt PC, Vollmer RT, Shelburne JD, et al: Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project. I. Light microscopy. Am J Pathol. 1979; 95: 191-214. 17) Hudson LD, Milberg JA, Anardi D, et al: Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995; 151: 293-301. 9) Zeiher BG, Artigas A, Vincent JL, et al: Neutrophil elastase inhibition in acute lung injury: results of the STRIVE study. Crit Care Med. 2004; 32: 1695-702. 2) Rubenfeld GD, Caldwell E, Granton J, et al: Interobserver variability in applying a radiographic definition for ARDS. Chest. 1999; 116: 1347-53. 20) Gushima Y, Ichikado K, Suga M, et al: Expression of matrix metalloproteinases in pigs with hyperoxia-induced acute lung injury. Eur Respir J. 2001; 18: 827-37. 19) Ichikado K, Suga M, Muranaka H, et al: Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology. 2006; 238: 321-9. 18) Ichikado K, Muranaka H, Gushima Y, et al: Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study. BMJ Open. 2012; 2: e000545 8) Gattinoni L, Pelosi P, Suter PM, et al: Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med. 1998; 158: 3-11. 16) Doyle RL, Szaflarski N, Modin GW, et al: Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med. 1995; 152: 1818-24. 5) Ichikado K, Suga M, Gushima Y, et al: Hyperoxia-induced diffuse alveolar damage in pigs: correlation between thin-section CT and histopathologic findings. Radiology. 2000; 216: 531-8. 14) Murray JF, Matthay MA, Luce JM, et al: An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988; 138: 720-3. 12) Bone RC, Balk RA, Cerra FB, et al: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101: 1644-55. 6) Ichikado K, Suga M, Müller NL, et al: Acute interstitial pneumonia: comparison of high-resolution computed tomography findings between survivors and nonsurvivors. Am J Respir Crit Care Med. 2002; 165: 1551-6. 15) Ware LB, Matthay MA: The acute respiratory distress syndrome. N Engl J Med. 2000; 342: 1334-49. 11) Members of American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992; 20: 864-74. |
| References_xml | – reference: 2) Rubenfeld GD, Caldwell E, Granton J, et al: Interobserver variability in applying a radiographic definition for ARDS. Chest. 1999; 116: 1347-53. – reference: 3) Pratt PC, Vollmer RT, Shelburne JD, et al: Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project. I. Light microscopy. Am J Pathol. 1979; 95: 191-214. – reference: 7) Tomashefski JF Jr: Pulmonary pathology of acute respiratory distress syndrome. Clin Chest Med. 2000; 21: 435-66. – reference: 15) Ware LB, Matthay MA: The acute respiratory distress syndrome. N Engl J Med. 2000; 342: 1334-49. – reference: 16) Doyle RL, Szaflarski N, Modin GW, et al: Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med. 1995; 152: 1818-24. – reference: 6) Ichikado K, Suga M, Müller NL, et al: Acute interstitial pneumonia: comparison of high-resolution computed tomography findings between survivors and nonsurvivors. Am J Respir Crit Care Med. 2002; 165: 1551-6. – reference: 14) Murray JF, Matthay MA, Luce JM, et al: An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988; 138: 720-3. – reference: 5) Ichikado K, Suga M, Gushima Y, et al: Hyperoxia-induced diffuse alveolar damage in pigs: correlation between thin-section CT and histopathologic findings. Radiology. 2000; 216: 531-8. – reference: 11) Members of American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992; 20: 864-74. – reference: 9) Zeiher BG, Artigas A, Vincent JL, et al: Neutrophil elastase inhibition in acute lung injury: results of the STRIVE study. Crit Care Med. 2004; 32: 1695-702. – reference: 4) Ichikado K, Johkoh T, Ikezoe J, et al: Acute interstitial pneumonia: high-resolution CT findings correlated with pathology. AJR Am J Roentgenol. 1997; 168: 333-8. – reference: 10) Tamakuma S, Ogawa M, Aikawa N, et al: Relationship between neutrophil elastase and acute lung injury in humans. Pulm Pharmacol Ther. 2004; 17: 271-9. – reference: 13) ARDS network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000; 342: 1301-8. – reference: 1) Bernard GR, Artigas A, Brigham KL, et al: The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994; 149: 818-24. – reference: 18) Ichikado K, Muranaka H, Gushima Y, et al: Fibroproliferative changes on high-resolution CT in the acute respiratory distress syndrome predict mortality and ventilator dependency: a prospective observational cohort study. BMJ Open. 2012; 2: e000545 – reference: 12) Bone RC, Balk RA, Cerra FB, et al: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101: 1644-55. – reference: 17) Hudson LD, Milberg JA, Anardi D, et al: Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995; 151: 293-301. – reference: 20) Gushima Y, Ichikado K, Suga M, et al: Expression of matrix metalloproteinases in pigs with hyperoxia-induced acute lung injury. Eur Respir J. 2001; 18: 827-37. – reference: 19) Ichikado K, Suga M, Muranaka H, et al: Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology. 2006; 238: 321-9. – reference: 8) Gattinoni L, Pelosi P, Suter PM, et al: Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med. 1998; 158: 3-11. |
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| Title | Clinical course of patients with ALI/ARDS treated with sivelestat: comparison of effects on direct and indirect lung injury using high-resolution CT and clinical parameters |
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