Dataset Information

Sildenafil attenuates pulmonary arterial pressure but does not improve oxygenation during ARDS.

ABSTRACT:

Objective

Pulmonary hypertension is a characteristic feature of acute respiratory distress syndrome (ARDS) and contributes to mortality. Administration of sildenafil in ambulatory patients with pulmonary hypertension improves oxygenation and ameliorates pulmonary hypertension. Our aim was to determine whether sildenafil is beneficial for patients with ARDS.

Design

Prospective, open-label, multicenter, interventional cohort study.

Setting

Medical-surgical ICU of two university hospitals.

Patients

Ten consecutive patients meeting the NAECC criteria for ARDS.

Interventions

A single dose of 50 mg sildenafil citrate administered via a nasogastric tube.

Main results

Administration of sildenafil in patients with ARDS decreased mean pulmonary arterial pressure from 25 to 22 mmHg (P = 0.022) and pulmonary artery occlusion pressure from 16 to 13 mmHg (P = 0.049). Systemic mean arterial pressures were markedly decreased from 81 to 75 mmHg (P = 0.005). Sildenafil did not improve pulmonary arterial oxygen tension, but resulted in a further increase in the shunt fraction.

Conclusion

Although sildenafil reduced pulmonary arterial pressures during ARDS, the increased shunt fraction and decreased arterial oxygenation render it unsuitable for the treatment of patients with ARDS.

SUBMITTER: Cornet AD

PROVIDER: S-EPMC2850529 | biostudies-literature | 2010 May

REPOSITORIES: biostudies-literature

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Publications

Sildenafil attenuates pulmonary arterial pressure but does not improve oxygenation during ARDS.

Cornet Alexander D AD Hofstra Jorrit J JJ Swart Eleonora L EL Girbes Armand R J AR Juffermans Nicole P NP

Intensive care medicine 20100204 5

<h4>Objective</h4>Pulmonary hypertension is a characteristic feature of acute respiratory distress syndrome (ARDS) and contributes to mortality. Administration of sildenafil in ambulatory patients with pulmonary hypertension improves oxygenation and ameliorates pulmonary hypertension. Our aim was to determine whether sildenafil is beneficial for patients with ARDS.<h4>Design</h4>Prospective, open-label, multicenter, interventional cohort study.<h4>Setting</h4>Medical-surgical ICU of two universi ...[more]

PMID: 20130830

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Project description:BACKGROUND:Patients with pulmonary arterial hypertension (PAH) have lower cerebral blood flow (CBF) and oxygenation compared to healthy sedentary subjects, the latter negatively correlating with exercise capacity during incremental cycling exercise. We hypothesized that patients would also exhibit altered CBF and oxygenation during endurance exercise, which would correlate with endurance time. METHODS:Resting and exercise cardiorespiratory parameters, blood velocity in the middle cerebral artery (MCAv; transcranial doppler) and cerebral oxygenation (relative changes in cerebral tissue oxygenation index (?cTOI) and cerebral deoxyhemoglobin (?cHHb); near-infrared spectroscopy) were continuously monitored in nine PAH patients and 10 healthy-matched controls throughout endurance exercise. Cardiac output (CO), systemic blood pressure (BP) and oxygen saturation (SpO2 ), ventilatory metrics and end-tidal CO2 pressure (PET CO2 ) were also assessed noninvasively. RESULTS:Despite a lower workload and endurance oxygen consumption, similar CO and systemic BP, ?cTOI was lower in PAH patients compared to controls (p < .01 for interaction). As expected during exercise, patients were characterized by an altered MCAv response to exercise, a lower PET CO2 and SpO2 , as wells as a higher minute-ventilation/CO2 production ratio ( V?E/V?CO2 ratio). An uncoupling between changes in MCAv and PET CO2 during the cycling endurance exercise was also progressively apparent in PAH patients, but absent in healthy controls. Both cHHb and ?cTOI correlated with V?E/V?CO2 ratio (r = 0.50 and r = -0.52; both p < .05 respectively), but not with endurance time. CONCLUSION:PAH patients present an abnormal cerebrovascular profile during endurance exercise with a lower cerebral oxygenation that correlate with hyperventilation but not endurance exercise time. These findings complement the physiological characterization of the cerebral vascular responses to exercise in PAH patients.

Project description:BackgroundSildenafil is a cyclic guanosine monophosphate-specific phosphodiesterase-5 inhibitor used for treating pulmonary hypertension. Although the use of sildenafil in patients under 18 years old is off-label, this inhibitor has been widely prescribed for children treatment at hospitals in Brazil. In this work we evaluated the current practices in using sildenafil in the three main reference hospitals of Rio de Janeiro to design a clinical trial. Then we analyzed the content of sildenafil in powder paper preparations used in these institutions.Methods and resultsWe assessed the data about the use of sildenafil in three reference hospitals including Instituto Nacional de Cardiologia - INC, Instituto Estadual de Cardiologia Aloysio de Castro - IECAC and Hospital Pro-Cardíaco - HPC. The pharmacy records were analyzed from April 1st, 2008 to April 30th, 2008 and interviews with the pharmacists were also performed. Our results showed that INC used the greatest amount of sildenafil in: treatment of pulmonary arterial hypertension (PAH), management of transient PAH during surgery, preparation for cardiac transplantation and haemodynamic studies during cardiac catheterization. Meanwhile IECAC and HPC used sildenafil only for treating PAH in few patients during the period evaluated. In INC and IECAC, sildenafil was available in tablets, and powder papers prepared by two private pharmacies and one public hospital pharmacy. In contrast all patients of HPC received sildenafil in tablets with no external manipulation. Our quantification analysis results using reverse-phase high performance liquid chromatography method showed that powder papers prepared by the private pharmacies from the sildenafil tablets presented only 58.5 to 89.3% of the declared concentration in contrast to samples from the public hospital pharmacy (104.4 to 105.3%).ConclusionFew patients received the prescribed sildenafil dose at the reference hospitals evaluated in Rio de Janeiro, which may importantly compromise this inhibitor effect in the current treatment. This study reinforced the need of checking the practices of preparing and administering sildenafil continually.

Dataset Information

Sildenafil attenuates pulmonary arterial pressure but does not improve oxygenation during ARDS.

Objective

Design

Setting

Patients

Interventions

Main results

Conclusion

Publications

Sildenafil attenuates pulmonary arterial pressure but does not improve oxygenation during ARDS.

Similar Datasets

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