|Intravenous sildenafil and inhaled nitric oxide: a randomised trial in infants after cardiac surgery.|
|PMID: 14530859 Owner: NLM Status: MEDLINE|
|OBJECTIVE: To investigate the acute effects of intravenous sildenafil on haemodynamics and oxygenation, and its interaction with inhaled nitric oxide (iNO) in infants at risk of pulmonary hypertension early after cardiac surgery. DESIGN: Prospective, randomised trial. SETTING: Paediatric intensive care unit of a children's hospital. PATIENTS AND PARTICIPANTS: Sixteen ventilated infants early after closure of ventricular or atrioventricular septal defects, were randomly assigned to one of two groups. The study was completed in 15 infants. INTERVENTIONS: Studies were commenced within 7 h of separation from bypass. Seven infants received iNO (20 ppm) first, with the addition of intravenous sildenafil (0.35 mg/kg over 20 min) after 20 min. Eight infants received sildenafil first, iNO was added after 20 min. Vascular pressures, cardiac output and a blood gas were recorded at 0, 20 and 40 min. MEASUREMENTS AND RESULTS: In infants receiving iNO first, iNO lowered the pulmonary vascular resistance index (PVRI) from 3.45 to 2.95 units (p=0.01); sildenafil further reduced PVRI to 2.45 units p<0.05). In those receiving sildenafil first, PVRI was reduced from 2.84 to 2.35 units (p<0.05) with sildenafil, and fell to 2.15 units (p=0.01) with the addition of iNO. In both groups, sildenafil reduced the systemic blood pressure and systemic vascular resistance (p<0.01) and worsened arterial oxygenation and the alveolar-arterial gradient (p<0.05). CONCLUSION: Intravenous sildenafil augmented the pulmonary vasodilator effects of iNO in infants early after cardiac surgery. However, sildenafil produced systemic hypotension and impaired oxygenation, which was not improved by iNO.|
|Christian Stocker; Daniel J Penny; Christian P Brizard; Andrew D Cochrane; Rodrigo Soto; Lara S Shekerdemian|
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|Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2003-10-07|
|Title: Intensive care medicine Volume: 29 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 2003 Nov|
|Created Date: 2003-11-10 Completed Date: 2004-02-13 Revised Date: 2007-11-15|
Medline Journal Info:
|Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States|
|Languages: eng Pagination: 1996-2003 Citation Subset: IM|
|Department of Intensive Care, Royal Children's Hospital, Flemington Road, 3052, Parkville, Victoria, Australia.|
|APA/MLA Format Download EndNote Download BibTex|
Blood Pressure / drug effects
Bronchodilator Agents / pharmacology, therapeutic use*
Cardiac Output / drug effects
Drug Therapy, Combination
Heart Septal Defects, Atrial / surgery
Heart Septal Defects, Ventricular / surgery
Hypertension, Pulmonary / etiology, prevention & control*
Nitric Oxide / pharmacology, therapeutic use*
Piperazines / pharmacology, therapeutic use*
Postoperative Complications / etiology, prevention & control*
Pulmonary Circulation / drug effects
Vascular Resistance / drug effects
Vasodilator Agents / pharmacology, therapeutic use*
|0/Bronchodilator Agents; 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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