Document Detail


Inhaled NO and sildenafil combination in cardiac surgery patients with out-of-proportion pulmonary hypertension: acute effects on postoperative gas exchange and hemodynamics.
MedLine Citation:
PMID:  22057829     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The goal of this study was to examine the effects of coadministration of sildenafil and inhaled nitric oxide (iNO) in patients with out-of-proportion pulmonary hypertension who underwent cardiac valve replacement surgery.
METHODS AND RESULTS: Twenty consecutive cardiac surgery patients with out-of-proportion pulmonary hypertension were randomly assigned postoperatively into 2 groups: group A received 10 ppm of iNO followed by sildenafil (100 mg) orally 30 minutes later, and group B initially received sildenafil (100 mg) orally followed by 10 ppm of iNO 60 minutes later. Hemodynamic and gas exchange data were obtained at baseline, after administration of either iNO or sildenafil alone, and at 90 minutes from baseline. In group A, iNO resulted in a significant reduction in mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance index (PVRI) (by 9.6% and 20.8%, respectively). In group B, sildenafil administration also resulted in a significant decrease in mean arterial pressure, MPAP, pulmonary artery occlusive pressure, PVRI, and systemic vascular resistance index but also in the PaO(2)/inspired fraction of oxygen ratio (by 18.7%, 22.0%, 15.7%, 31.6%, 21.3%, and 14%, respectively). In both groups, the coadministration of the 2 drugs resulted in a significant further reduction of mean arterial pressure, MPAP, pulmonary artery occlusive pressure, systemic vascular resistance index, and PVRI, whereas cardiac index and mixed venous oxygen saturation remained unchanged. The hypoxemia after sildenafil administration in group B improved after the coadministration of iNO, and thus PaO(2)/inspired fraction of oxygen returned to values near baseline.
CONCLUSION: In this study, the postoperative coadministration of iNO and oral sildenafil in patients with out-of-proportion pulmonary hypertension undergoing cardiac surgery is safe and results in an additive favorable effect on pulmonary arterial pressure and pulmonary vascular resistance, without systemic hypotension and ventilation/perfusion mismatch.
Authors:
Dimitrios Matamis; Smaro Pampori; Athanasios Papathanasiou; Panagiota Papakonstantinou; Mathew Tsagourias; Eftichia Galiatsou; Vasilios Koulouras; George Nakos
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2011-11-04
Journal Detail:
Title:  Circulation. Heart failure     Volume:  5     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-18     Completed Date:  2012-04-13     Revised Date:  2012-05-24    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  47-53     Citation Subset:  IM    
Affiliation:
Intensive Care Unit, Papageorgiou General Hospital, Thessalonica, Greece.
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Administration, Oral
Aged
Blood Pressure / drug effects,  physiology
Cardiac Surgical Procedures*
Drug Therapy, Combination
Female
Heart Valve Diseases / surgery*
Hemodynamics / drug effects,  physiology*
Humans
Hypertension / drug therapy*,  physiopathology
Male
Middle Aged
Nitric Oxide / administration & dosage,  pharmacology,  therapeutic use*
Piperazines / administration & dosage,  pharmacology,  therapeutic use*
Postoperative Period
Prospective Studies
Pulmonary Gas Exchange / drug effects,  physiology*
Purines / administration & dosage,  pharmacology,  therapeutic use
Retrospective Studies
Sulfones / administration & dosage,  pharmacology,  therapeutic use*
Vascular Resistance / drug effects,  physiology
Vasodilator Agents / administration & dosage,  pharmacology,  therapeutic use
Chemical
Reg. No./Substance:
0/Piperazines; 0/Purines; 0/Sulfones; 0/Vasodilator Agents; 10102-43-9/Nitric Oxide; 139755-83-2/sildenafil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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