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Re: Case report:Treatment of Pulmonary hypertension in the general adult intensive care unit: a role
- Dr Brendan Patrick Madden, Dr Agnieszka Crerar-Gilbert (29 June 2005)
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Dr Brendan Patrick Madden, Medical Consultant St George's Hospital, Tooting, London, Dr Agnieszka Crerar-Gilbert
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CARDIOTHORACIC UNIT Atkinson Morley Wing, St. George’s Hospital Consultant Physician: Dr B P Madden – Tel 020 8725 1094 27 June 2005 The Editor British Journal of Anaesthesia Dear Editor, Re.: Case report:Treatment of pulmonary hypertension in the general adult intensive care unit: a role for oral Sildenafil Authors: Dr J Ng1 and colleagues We read with interest the recent case report by Drs Ng1 and colleagues describing the use of oral Sildenafil in the management of a patient with secondary pulmonary hypertension in a general adult intensive care unit. The authors quite rightly state that by and large the medical literature contains small observational studies and case reports on sildenafil use in patients with pulmonary hypertension. Nevertheless we wish to point out that we have been using both oral and intravenous sildenafil in the Cardiothoracic and adult intensive care units in St George’s Hospital for the past three years and indeed have described encouraging results in the intensive care unit using oral sildenafil therapy to treat peri-operative pulmonary hypertensive crises in cardiac surgical patients. This work was published in the British Journal of Anaesthesia last year2 . Indeed oral sildenafil has become an important treatment in our intensive care unit to address perioperative pulmonary hypertension in cardiac surgical patients. In addition we have had encouraging experience with oral sildenafil in the management of patients with pulmonary hypertension secondary to a variety of pulmonary conditions including chronic pulmonary thromboembolic disease3. We have used doses of 25mg to 50mg tds and have not encountered problematic systemic hypotension to date. We agree entirely with the authors that further studies are warranted to address the haemodynamic benefits of sildenafil in critically ill patients. It is hoped that ongoing multidisciplinary collaboration will help to achieve this. Yours sincerely. Dr Brendan Madden, MD, MSc, FRCP, FRCPI Consultant Cardiothoracic and ITU Physician Reader in Cardiothoracic Medicine Dr Agnieszka Crerar-Gilbert FRCA Consultant Cardiothoracic Anaesthesia and Intensive Care Reference 1. Ng J, Finney SJ, Shulman R, Bellingan GJ, Singer M, Glynne PA. Treatment of pulmonary hypertension in the general adult intensive care unit: a role for oral sildenafil ? Br J Anaesth 2005; 94:774-7 2. Madden BP, Sheth A, Ho TB, Park JE, Kanagasabay RR. Potential role for sildenafil in the management of perioperative pulmonary hypertension and right ventricular dysfunction after cardiac surgery. Br J Anaesth 2004;93: 155-6. 3. Sheth A, Park JE, Ong YE, Ho TB, Madden BP. Early haemodynamic benefit of sildenafil in patients with coexisting chronic thromboembolic pulmonary hypertension and left ventricular dysfunction. Vascul Pharmacol 2005;42: 41-5 Conflict of Interest:None declared |
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