title: Treatment of pulmonary hypertension in the general adult intensive care unit: a role for oral sildenafil?
abstract: Use of inhaled nitric oxide for treatment of pulmonary hypertension in adult critical illness is limited by its mode of delivery and high costs, prompting evaluation of alternative therapies. We report the use of oral sildenafil in a patient with severe secondary pulmonary hypertension and right ventricular dysfunction. Following reduction in mean pulmonary artery pressure and pulmonary vascular resistance with inhaled nitric oxide, crossover to sildenafil therapy maintained control of pulmonary hypertension, facilitating discontinuation of respiratory and cardiovascular organ support. The relative pulmonary vascular specificity of oral sildenafil, and its low cost, makes it an attractive therapeutic alternative to inhaled nitric oxide, and warrants further study.
authors.affiliation: Department of Critical Care, University College London Hospitals, Mortimer Street, London W1T 3AA, UK.
authors.forename: J
authors.initials: J
authors.lastname: Ng
authors.forename: S J
authors.initials: SJ
authors.lastname: Finney
authors.forename: R
authors.initials: R
authors.lastname: Shulman
authors.forename: G J
authors.initials: GJ
authors.lastname: Bellingan
authors.forename: M
authors.initials: M
authors.lastname: Singer
authors.forename: P A
authors.initials: PA
authors.lastname: Glynne
mesh_terms: D000284:Administration, Oral; D000368:Aged; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate