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01-11-2003 | Neonatal and Pediatric Intensive Care

Intravenous sildenafil and inhaled nitric oxide: a randomised trial in infants after cardiac surgery

Authors: Christian Stocker, Daniel J. Penny, Christian P. Brizard, Andrew D. Cochrane, Rodrigo Soto, Lara S. Shekerdemian

Published in: Intensive Care Medicine | Issue 11/2003

Abstract

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.

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Title: Intravenous sildenafil and inhaled nitric oxide: a randomised trial in infants after cardiac surgery
Authors: Christian Stocker
Daniel J. Penny
Christian P. Brizard
Andrew D. Cochrane
Rodrigo Soto
Lara S. Shekerdemian
Publication date: 01-11-2003
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 11/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-2016-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intravenous sildenafil and inhaled nitric oxide: a randomised trial in infants after cardiac surgery

Abstract

Objective

Design

Setting

Patients and participants

Interventions

Measurements and results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients and participants

Interventions

Measurements and results

Conclusion

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