Abstract
Purpose
To clarify the clinical significance of sivelestat sodium (SIV) administration, we surveyed the status of 40 patients treated with SIV for respiratory dysfunction following surgery.
Methods
The subjects were patients who received SIV administration due to systemic inflammatory response syndrome (SIRS) and respiratory dysfunction (PaO2/FIO2 ratio ≤300 mmHg) after surgery at the Department of Surgery and Science, Kyushu University, and related facilities between April and December 2008.
Results
The most frequent underlying condition was perforation of the digestive tract, followed by cancer of the upper digestive organs. The main causes of SIRS were surgical stress and infection. The mean P/F ratio at the initiation of SIV administration was 185.5 ± 72.0 mmHg. The ratio increased, and the number of SIRS-related factors decreased with time after SIV administration. Sivelestat sodium was administered within 24 h after the onset of respiratory dysfunction in 87.5% of the patients, and the survival rate at 28 days after the initiation of SIV administration was 90.0%.
Conclusion
Our findings suggest that multidisciplinary postoperative management, including the administration of SIV, during the early phase after the onset of respiratory dysfunction leads to improvements in respiratory function and survival.
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References
Haga Y, Beppu T, Doi K, Nozawa F, Mugita N, Ikei S, et al. Systemic inflammatory response syndrome and organ dysfunction following gastrointestinal surgery. Crit Care Med 1997;25:1994–2000.
Gando S, Nanzaki S, Kemmotsu O. Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma: application of clinical decision analysis. Ann Surg 1999;229:121–127.
Bone RC. Sir Isaac Newton, sepsis, SIRS, and CARS. Crit Care Med 1996;24:1125–1128.
Fujishima S, Sasaki J, Shinozawa Y, Takuma K, Kimura H, Suzuki M, et al. Serum MIP-1 alpha and IL-8 in septic patients. Intensive Care Med 1996;22:1169–1175.
Okusawa S, Gelfand JA, Ikejima T, Connolly RJ, Dinarello CA. Interleukin 1 induces a shock-like state in rabbits. Synergism with tumor necrosis factor and the effect of cyclooxygenase inhibition. J Clin Invest 1988;81:1162–1172.
Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000;342:1334–1349.
Lee CT, Fein AM, Lippmann M, Holtzman H, Kimbel P, Weinbaum G. Elastolytic activity in pulmonary lavage fluid from patients with adult respiratory-distress syndrome. N Engl J Med 1981;304:192–196.
Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988;138:720–723.
Tamakuma S, Shiba T, Hirasawa H, Ogawa M, Nakashima M. A phase III clinical study of a neutrophil elastase inhibitor, ONO-5046 Na, in SIRS patients (in Japanese with English abstract). J Clin Ther Med 1998;14:289–318.
Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, et al. Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 1998;158:1076–1081.
Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG, et al. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med 1999;159:1849–1861.
Bersten AD, Edibam C, Hunt T, Moran J; Australian and New Zealand Intensive Care Society Clinical Trials Group. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian States. Am J Respir Crit Care Med 2002;165:443–448.
Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, et al.; ALIVE Study Group. Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med 2004;30:51–61.
Kadoi Y, Hinohara H, Kunimoto F, Saito S, Goto F, Kosaka T, et al. Pilot study of the effects of ONO-5046 in patients with acute respiratory distress syndrome. Anesth Analg 2004;99:872–877.
Endo S, Sato N, Yaegashi Y, Suzuki Y, Kojika M, Yamada Y, et al. Sivelestat sodium hydrate improves septic acute lung injury by reducing alveolar dysfunction. Res Commun Mol Pathol Pharmacol 2006;119:53–65.
Ono S, Tsujimoto H, Hiraki S, Takahata R, Kimura A, Kinoshita M, et al. Effects of neutrophil elastase inhibitor on progression of acute lung injury following esophagectomy. World J Surg 2007;31:1996–2001.
Suda K, Kitagawa Y, Ozawa S, Miyasho T, Okamoto M, Saikawa Y, et al. Neutrophil elastase inhibitor improves postoperative clinical courses after thoracic esophagectomy. Dis Esophagus 2007;20:478–486.
Saeki H, Ishimura H, Higashi H, Kitagawa D, Tanaka J, Maruyama R, et al. Postoperative management using intensive patient-controlled epidural analgesia and early rehabilitation after an esophagectomy. Surg Today 2009;39:476–480.
Ryugo M, Sawa Y, Takano H, Matsumiya G, Iwai S, Ono M, et al. Effect of a polymorphonuclear elastase inhibitor (sivelestat sodium) on acute lung injury after cardiopulmonary bypass: findings of a double-blind randomized study. Surg Today 2006;36:321–326.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818–824.
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Saeki, H., Morita, M., Harada, N. et al. A survey of the effects of sivelestat sodium administration on patients with postoperative respiratory dysfunction. Surg Today 40, 1034–1039 (2010). https://doi.org/10.1007/s00595-010-4296-y
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DOI: https://doi.org/10.1007/s00595-010-4296-y