title: Dramatic beneficial effects of sildenafil in recurrent massive pulmonary embolism.
abstract: OBJECTIVE
  Sildenafil has a well established pulmonary vasodilatory effect, but has seldom been used in critically ill patients. We report a case of severe recurrent pulmonary embolism in which sildenafil was used as a rescue therapy.
  
  
  RESULTS
  After oral administration of 50 mg of sildenafil, cardiac index increased from 2.11/min/m(2) to 3.21/min/m(2); mean pulmonary artery pressure decreased from 56 mmHg to 46 mmHg, and pulmonary vascular resistance index decreased from 700 dynes/cm(-5)/m(2) to 425 dynes/cm(-5)/m(2), without reduction of arterial systemic pressure. Clinical condition also improved during the following days under treatment of 50 mg sildenafil three times daily.
  
  
  CONCLUSIONS
  These observations should stimulate studies with sildenafil in the ICU setting. Sildenafil is easy to administer in every ICU and at any time. If its potential is confirmed, it may be a life-saving drug in some emergency situations caused by severe pulmonary hypertension.
authors.affiliation: Hôpital Riviera, Site du Samaritain, Département de Médecine Interne, Boulevard Paderewski 5, 1800, Vevey, Switzerland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ganière
authors.forename: François
authors.initials: F
authors.lastname: Feihl
authors.forename: Damien
authors.initials: D
authors.lastname: Tagan
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000503:physiopathology; D011687:Purines / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D012720:Severity of Illness Index; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013557:Switzerland; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate