title: Sildenafil to facilitate weaning from inhaled nitric oxide and mechanical ventilation in a patient with severe secondary pulmonary hypertension and a patent foramen ovale.
abstract: We describe the case of a woman who presented to the intensive care unit with acute respiratory failure that required mechanical ventilation. She had severe pulmonary hypertension secondary to interstitial lung disease, and her history included sarcoidosis and tuberculosis. She was  dependent on inhaled nitric oxide (INO) to maintain safe arterial oxygen saturation and could not be weaned from mechanical ventilation. Echocardiography revealed a patent foramen ovale with substantial right-to-left shunt, which probably contributed to her hypoxemia. Sildenafil enabled weaning  from INO and substantially reduced the flow through the patent foramen ovale. She was successfully extubated and discharged home. To our knowledge, this is the first report of weaning from INO and mechanical ventilation in a patient with both severe secondary pulmonary hypertension and a right-to-left  shunt through a patent foramen ovale.
authors.affiliation: Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel. selias@hadassah.org.il
authors.forename: Shlomo
authors.initials: S
authors.lastname: Elias
authors.forename: Sigal
authors.initials: S
authors.lastname: Sviri
authors.forename: Efrat
authors.initials: E
authors.lastname: Orenbuch-Harroch
authors.forename: Yakov
authors.initials: Y
authors.lastname: Fellig
authors.forename: Arie
authors.initials: A
authors.lastname: Ben-Yehuda
authors.forename: Zvi G
authors.initials: ZG
authors.lastname: Fridlender
authors.forename: Dan
authors.initials: D
authors.lastname: Gilon
authors.forename: Abed
authors.initials: A
authors.lastname: Bayya
mesh_terms: D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D015897:Comorbidity; D004417:Dyspnea / Q000209:etiology; D005260:Female; D054092:Foramen Ovale, Patent / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D009569:Nitric Oxide / Q000008:administration & dosage*; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D011687:Purines / Q000008:administration & dosage / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000209:etiology*; D017565:Sarcoidosis, Pulmonary / Q000150:complications; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000008:administration & dosage / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015300:Ventilator Weaning / Q000379:methods*
chemical_list: D001993:Bronchodilator Agents; D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D009569:Nitric Oxide; D000068677:Sildenafil Citrate