This Article Full Text (OnlineFirst PDF) All Versions of this Article: 0885066608321389v1 23/5/329    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Lee, J. E. Articles by Knoderer, C. A. Search for Related Content PubMed PubMed Citation Articles by Lee, J. E. Articles by Knoderer, C. A. Social Bookmarking                         What's this?

Use of Sildenafil to Facilitate Weaning from Inhaled Nitric Oxide in Children with Pulmonary Hypertension following Surgery for Congential Heart Disease

¹ Dept of Pharmacy
² Dept of Anesthesia

^* To whom correspondence should be addressed. E-mail: cknoderer{at}clarian.org.

	Abstract

Pulmonary hypertension frequently complicates the postoperative management of patients after congenital cardiac surgery. Inhaled nitric oxide is an effective treatment option, but rebound pulmonary hypertension can occur upon its withdrawal. Sildenafil may facilitate its withdrawal by restoring cyclic guanosine monophosphate availability via phosphodiesterase-5 inhibition. The purpose of this study was to evaluate the use of sildenafil in facilitating weaning from inhaled nitric oxide after congenital cardiac surgery in patients who had previously failed weaning, and to compare the effects of sildenafil on pulmonary and systemic hemodynamics. Children who received sildenafil after cardiovascular surgery during a 23-month period at Riley Hospital for Children were identified. Medical records were retrospectively reviewed to determine sildenafil and nitric oxide dosing, pulmonary and systemic blood pressures, and adverse effects. Oral sildenafil was administered to 7 children who had failed attempts at inhaled nitric oxide weaning. Inhaled nitric oxide was weaned from 29.8 ± 5.9 ppm prior to sildenafil initiation to 12.2 ± 3.4 ppm (mean ± SE; P = .024) in the 24 hours after sildenafil. Mean pulmonary artery and systemic arterial pressure were unchanged from baseline when measured 1 hour after sildenafil dosing (mean pulmonary artery pressure, 29 ± 1 to 27 ± 0.7 mm Hg, P = .066; mean systemic arterial pressure, 56 ± 1.2 to 54 ± 1.2 mm Hg, P = .202). Sildenafil may facilitate withdrawal of inhaled nitric oxide and prevent rebound pulmonary hypertension in patients previously failing inhaled nitric oxide weaning attempts.

First published on August 12, 2008, doi:10.1177/0885066608321389

Journal of Intensive Care Medicine 2008;23:329.

A more recent version of this article appeared on September 1, 2008


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?