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Dramatic beneficial effects of sildenafil in recurrent massive pulmonary embolism.

Ganière V, Feihl F, Tagan D

Département de Médecine Interne, Hôpital Riviera, Site du Samaritain, Boulevard Paderewski 5, 1800, Vevey, Switzerland, damien.tagan@hopital-riviera.ch.

OBJECTIVE: Sildenafil has a well established pulmonary vasodilatory effect, but has seldom been used in critically ill patients. We report a case of severe recurrent pulmonary embolism in which sildenafil was used as a rescue therapy. RESULTS: After oral administration of 50[Symbol: see text]mg of sildenafil, cardiac index increased from 2.1[Symbol: see text]l/min/m(2) to 3.2[Symbol: see text]l/min/m(2); mean pulmonary artery pressure decreased from 56[Symbol: see text]mmHg to 46[Symbol: see text]mmHg, and pulmonary vascular resistance index decreased from 700[Symbol: see text]dynes/cm(-5)/m(2) to 425[Symbol: see text]dynes/cm(-5)/m(2), without reduction of arterial systemic pressure. Clinical condition also improved during the following days under treatment of 50[Symbol: see text]mg sildenafil three times daily. CONCLUSIONS: These observations should stimulate studies with sildenafil in the ICU setting. Sildenafil is easy to administer in every ICU and at any time. If its potential is confirmed, it may be a life-saving drug in some emergency situations caused by severe pulmonary hypertension.

Published 23 February 2006 in Intensive Care Med, 32(3): 452-4.
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