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Continuous Versus Intermittent Intravenous Sildenafil in Critically Ill Infants with Pulmonary Hypertension
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  • Chetan Sharma,
  • Joseph Burns,
  • Aparna Kulkarni,
  • Jane Cerise,
  • Fernando Molina Berganza,
  • Denise A. Hayes
Chetan Sharma
Baylor College of Medicine
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Joseph Burns
Cohen Children's Medical Center
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Aparna Kulkarni
Cohen Children's Medical Center
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Jane Cerise
Cohen Children's Medical Center
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Fernando Molina Berganza
Cohen Children's Medical Center
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Denise A. Hayes
Cohen Childrens Med Ctr
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Abstract

Abstract Continuous intravenous (IV) sildenafil may avoid the acute systemic vasodilatory effects of bolus dosing in infants with pulmonary hypertension (PH). We aimed to examine the tolerability of different methods of IV sildenafil administration. Methods: We retrospectively evaluated subjects less than 12 months old with PH, who had been started on IV sildenafil. Vital signs, oxygen requirement, and vasoactive-inotropic score (VIS) before and after sildenafil initiation were noted, as was the need for discontinuation due to side effects. Results: Forty-three subjects were identified (23 continuous, 20 intermittent dosing). There were no statistically significant differences between groups in gender or gestational age, but higher baseline inspired oxygen (FiO2) and VIS in the continuous group suggested a higher baseline severity of illness (p=0.012). After sildenafil initiation, there were no significant differences in the change in blood pressure, oxygen saturation, FiO2, or VIS between groups, and no difference in the number of subjects requiring discontinuation due to side effects (4 in the continuous group, 1 intermittent, p=0.35). Eight subjects (34.8%) in the continuous group and 3 (15%) in the intermittent group died (p=0.024). Conclusions: In this small cohort of infants with PH treated with continuous or intermittent IV sildenafil, there were no statistically significant differences between groups in the change in vital signs, VIS, and oxygen requirement, or the need for discontinuation of therapy due to side effects. A higher mortality rate in the continuous infusion group may be explained by higher baseline illness severity.

Peer review status:ACCEPTED

16 Jan 2021Submitted to Pediatric Pulmonology
18 Jan 2021Submission Checks Completed
18 Jan 2021Assigned to Editor
19 Jan 2021Reviewer(s) Assigned
13 Feb 2021Review(s) Completed, Editorial Evaluation Pending
15 Feb 2021Editorial Decision: Revise Major
02 Apr 20211st Revision Received
03 Apr 2021Submission Checks Completed
03 Apr 2021Assigned to Editor
03 Apr 2021Reviewer(s) Assigned
22 Apr 2021Review(s) Completed, Editorial Evaluation Pending
28 Apr 2021Editorial Decision: Revise Minor
22 May 20212nd Revision Received
24 May 2021Assigned to Editor
24 May 2021Submission Checks Completed
24 May 2021Reviewer(s) Assigned
25 May 2021Review(s) Completed, Editorial Evaluation Pending
25 May 2021Editorial Decision: Accept