Abstract
Objective: The administration of sivelestat for acute lung injury (ALI) was observed to be associated with a deterioration in the long-term prognosis based on a multicenter trial, and its usage was therefore cancelled in our ICU since 2007. In this study, we compared the prognosis of sepsis-induced ALI before and after changing the therapeutic strategy. Method: The subjects consisted of adult sepsis-induced ALI cases that were admitted to the ICU within 21 months before and after January 2007, and required mechanical ventilation within 24 hours. These patients were divided into 64 cases for the early group and 36 cases for the latter group, and they were compared with each other. Result: There was no difference between the two groups regarding patient background. Sivelestat was used in 54 cases (84.4%) in the early group and 4 cases (11.1%) in the later group. There was no significant difference in the 28-ventilator free days (VFD), the length of ICU stay, the length of hospital stay, or in-hospital mortality, but the mechanical ventilation time was significantly shorter in the latter group. Based on a multivariate analysis for in-hospital mortality, the odds ratio of the latter group was lower compared to the early group, at 0.269 (P = 0.028), while according to a multivariate analysis for in-hospital mortality and 28-VFD including the use of sivelestat, no prognosis-improving tendency due to sivelestat was observed. Conclusion: The prognosis of sepsis-induced ALI was not found to deteriorate after cancelling the administration of sivelestat.
