Recommendation: We do not suggest the use of neutrophil elastase inhibitors in adult patients with ARDS. (GRADE 2D, Strength of recommendation “weak recommendation” / Quality of evidence “very low”)

●Supplementary conditions: Neutrophil elastase inhibitors are reimbursed by the national health insurance system in Japan to treat patients with ARDS with the proviso that the use of neutrophil elastase inhibitors is not recommended in patients with multiple organ failure (four or more organs), burn injuries, or trauma. A nationwide survey conducted by the Japanese Respiratory Society in 2010 showed that neutrophil elastase inhibitors are widely used in Japan for the treatment of patients with ARDS.