Sepsis related acute respiratory distress syndrome(ARDS)is one of the serious complications of sepsis,with high morbidity and mortality.Neutrophil elastase(NE)plays an important role in its pathophysi-ological processes,involving in many processes such as alveolar-capillary barrier breakdown,oxidative stress and inflammatory response,autophagy,cell death and so on.Sivelestat sodium,as the only marketed specific NE inhibitor(NEI),shows great potential in reducing inflammatory responses and protecting lung tissue.This article mainly reviews the mechanism of NE and NEI in sepsis related ARDS,and briefly discusses the poten-tial treatment of sepsis related ARDS and sivelestat sodium,in order to provide reference for clinical treat-ment.