| Inhaled NO and sildenafil combination in cardiac surgery patients with out-of-proportion pulmonary hypertension: acute effects on postoperative gas exchange and hemodynamics. | |
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MedLine Citation:
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PMID: 22057829 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Dimitrios Matamis; Smaro Pampori; Athanasios Papathanasiou; Panagiota Papakonstantinou; Mathew Tsagourias; Eftichia Galiatsou; Vasilios Koulouras; George Nakos |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial Date: 2011-11-04 |
Journal Detail:
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Title: Circulation. Heart failure Volume: 5 ISSN: 1941-3297 ISO Abbreviation: Circ Heart Fail Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-01-18 Completed Date: 2012-04-13 Revised Date: 2012-05-24 |
Medline Journal Info:
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Nlm Unique ID: 101479941 Medline TA: Circ Heart Fail Country: United States |
Other Details:
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Languages: eng Pagination: 47-53 Citation Subset: IM |
Affiliation:
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Intensive Care Unit, Papageorgiou General Hospital, Thessalonica, Greece. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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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