Noninvasive mechanical ventilation and neutrophil elastase inhibitor: Is it a new potential approach to acute hypoxemic failure?

摘要

Oxygenation impairment shown by a decreasing PaO2/FiO2 ratio is one of the most well-documented predictor of noninvasive mechanical ventilation (NIV) failure in acute lung injury (ALI)-acute respiratory distress syndrome (ARDS) [1], Mechanisms are developed by complex inflammatory pathways triggered by releasing inflammatory neutrophils [2].Tsushima et al [3] described effects on oxygenation index of neutrophil elastase inhibitor (NEI) during NIV, and main conclusions were that baseline PaO2/FiO2 greater than 150 mm Hg and the lung injury score improved significantly. We want to congratulate them for this interesting new combined approach of 2 therapies, pharmacology and NIV approach, to improve oxygenation in ARDS-ALI. However, some methodological aspects need remarks for a proper practical extrapolation.