title: Vardenafil and weaning from inhaled nitric oxide: effect on pulmonary hypertension in ARDS.
abstract: We report a 66-year-old patient with refractory pulmonary hypertension secondary to ARDS who was being treated with inhaled nitric oxide. Enteral vardenafil (phosphodiesterase-5 inhibitor) was tried at two different doses (10 mg and 5 mg), in order to wean the patient from nitric oxide. The higher dose decreased pulmonary pressure but caused systemic hypotension and the drug was discontinued. Subsequently, a 5 mg dose of vardenafil decreased pulmonary pressure without hypotension. Pulmonary hypertension was controlled using vardenafil 10-15 mg divided in 2-3 daily doses. This therapy allowed nitric oxide withdrawal, weaning from mechanical ventilation and discharge from ICU Vardenafil acted in synergy with inhaled nitric oxide, permitted nitric oxide reduction and discontinuation and proved to be effective as a single, long-term treatment for pulmonary hypertension.
authors.affiliation: Anesthesia and Intensive Care Department, Cardiology Department and Pneumology Unit, Milan University, San Paolo Hospital, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Giacomini
authors.forename: E
authors.initials: E
authors.lastname: Borotto
authors.forename: L
authors.initials: L
authors.lastname: Bosotti
authors.forename: T
authors.initials: T
authors.lastname: Denkewitz
authors.forename: C
authors.initials: C
authors.lastname: Reali-Forster
authors.forename: P
authors.initials: P
authors.lastname: Carlucci
authors.forename: S
authors.initials: S
authors.lastname: Centanni
authors.forename: A
authors.initials: A
authors.lastname: Mantero
authors.forename: G
authors.initials: G
authors.lastname: Iapichino
mesh_terms: D000280:Administration, Inhalation; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000209:etiology; D007093:Imidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000150:complications*; D016879:Salvage Therapy; D013450:Sulfones / Q000008:administration & dosage / Q000627:therapeutic use; D014227:Triazines / Q000008:administration & dosage / Q000627:therapeutic use; D000069058:Vardenafil Dihydrochloride; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D007093:Imidazoles; D010879:Piperazines; D013450:Sulfones; D014227:Triazines; D014665:Vasodilator Agents; D009569:Nitric Oxide; D000069058:Vardenafil Dihydrochloride