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BJA Advance Access published online on March 11, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei114
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted February 3, 2005

Case Report

Treatment of pulmonary hypertension in the general adult intensive care unit: a role for oral sildenafil?

J. Ng 1, S. J. Finney 1, R. Shulman 2, G. J. Bellingan 1, M. Singer 1, and P. A. Glynne 3*

1 Department of Critical Care, University College London Hospitals, Mortimer Street, London W1T 3AA, UK
2 Department of Pharmacy, University College London Hospitals, Mortimer Street, London W1T 3AA, UK
3 Department of Critical Care, University College London Hospitals, Mortimer Street, London W1T 3AA, UK; Institute of Hepatology, Department of Medicine, University College London, 69-75 Chenies Mews, London WC1E 6HX, UK

* To whom correspondence should be addressed.
P. A. Glynne, E-mail: p.glynne{at}ucl.ac.uk


  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.

Keywords: complications, pulmonary hypertension; enzymes, phosphodiesterase, inhibition; inhibitors, sildenafil; intensive care; nitric oxide, inhaled.
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Re: Case report:Treatment of Pulmonary hypertension in the general adult intensive care unit: a role
Dr Brendan Patrick Madden, et al.
British Journal of Anaesthesia, 29 Jun 2005 [Full text]

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