Journal Article

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

Hofstra, Jorrit J., Cornet, Alexander D., Swart, Eleonora L., Juffermans, Nicole P., Girbes, Armand R. J.

2010

Overview

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.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: 3',5'-Cyclic-GMP Phosphodiesterases - antagonists & inhibitors / Acute respiratory distress syndrome / Adult / Aged / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Anesthesiology / Biological and medical sciences / Blood pressure / Cohort Studies / Critical Care Medicine / Emergency Medicine / Female / Health aspects / Hospitals / Humans / Hypertension, Pulmonary - blood / Hypertension, Pulmonary - drug therapy / Hypertension, Pulmonary - physiopathology / Intensive / Intensive care medicine / Intensive Care Units / Male / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Netherlands / Original / Oxygen - blood / Oxygen Consumption - drug effects / Pain Medicine / Pediatrics / Piperazines - administration & dosage / Pneumology / Pneumology/Respiratory System / Prospective Studies / Pulmonary Artery - drug effects / Pulmonary hypertension / Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases / Purines - administration & dosage / Respiratory Distress Syndrome, Adult - blood / Respiratory Distress Syndrome, Adult - drug therapy / Respiratory Distress Syndrome, Adult - physiopathology / Sildenafil / Sildenafil Citrate / Sulfones - administration & dosage / United Kingdom / Vasodilator Agents - administration & dosage