Pulmonary hypertension and sildenafil

Abstract

Editor—We read with interest the recent case report by Dr Ng and colleagues1Ng J Finney SJ Shulman R Bellinghan GJ Singer M Glynne PA Treatment of pulmonary hypertension in the general adult intensive care unit: a role of oral Sildenafil?.Br J Anaesth. 2005; 94: 774-777Crossref PubMed Scopus (31) Google Scholar 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 of its use in patients with pulmonary hypertension. Nevertheless, we wish to point out that we have been using both oral and i.v. sildenafil in the cardiothoracic and adult intensive care units in St George's Hospital for the past 3 yr and, indeed, have described encouraging results using oral therapy to treat perioperative pulmonary hypertensive crises in cardiac surgical patients.2Madden 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: 155-156Crossref PubMed Scopus (24) Google Scholar It 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 administration in the management of patients with pulmonary hypertension secondary to a variety of pulmonary conditions including chronic pulmonary thromboembolic disease.3Sheth 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: 41-45Crossref PubMed Scopus (44) Google Scholar We have used doses of 25 mg to 50 mg three times daily and have not encountered problematic systemic hypotension to date. We agree 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.