Document Detail


Intravenous sildenafil and inhaled nitric oxide: a randomised trial in infants after cardiac surgery.
MedLine Citation:
PMID:  14530859     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Christian Stocker; Daniel J Penny; Christian P Brizard; Andrew D Cochrane; Rodrigo Soto; Lara S Shekerdemian
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2003-10-07
Journal Detail:
Title:  Intensive care medicine     Volume:  29     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2003 Nov 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  1996-2003     Citation Subset:  IM    
Affiliation:
Department of Intensive Care, Royal Children's Hospital, Flemington Road, 3052, Parkville, Victoria, Australia.
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Blood Pressure / drug effects
Bronchodilator Agents / pharmacology,  therapeutic use*
Cardiac Output / drug effects
Drug Synergism
Drug Therapy, Combination
Female
Heart Septal Defects, Atrial / surgery
Heart Septal Defects, Ventricular / surgery
Humans
Hypertension, Pulmonary / etiology,  prevention & control*
Infant
Infant, Newborn
Infusions, Intravenous
Male
Nitric Oxide / pharmacology,  therapeutic use*
Piperazines / pharmacology,  therapeutic use*
Postoperative Complications / etiology,  prevention & control*
Prospective Studies
Pulmonary Circulation / drug effects
Purines
Risk Factors
Sulfones
Treatment Outcome
Vascular Resistance / drug effects
Vasodilator Agents / pharmacology,  therapeutic use*
Chemical
Reg. No./Substance:
0/Bronchodilator Agents; 0/Piperazines; 0/Purines; 0/Sulfones; 0/Vasodilator Agents; 10102-43-9/Nitric Oxide; 139755-83-2/sildenafil

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