Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands.
Intensive Care Med. 2010 May;36(5):758-64. doi: 10.1007/s00134-010-1754-3. Epub 2010 Feb 4.
Pulmonary hypertension is a characteristic feature of acute respiratory distress syndrome (ARDS) and contributes to mortality. Administration of sildenafil in ambulatory patients with pulmonary hypertension improves oxygenation and ameliorates pulmonary hypertension. Our aim was to determine whether sildenafil is beneficial for patients with ARDS.
Prospective, open-label, multicenter, interventional cohort study.
Medical-surgical ICU of two university hospitals.
Ten consecutive patients meeting the NAECC criteria for ARDS.
A single dose of 50 mg sildenafil citrate administered via a nasogastric tube.
Administration of sildenafil in patients with ARDS decreased mean pulmonary arterial pressure from 25 to 22 mmHg (P = 0.022) and pulmonary artery occlusion pressure from 16 to 13 mmHg (P = 0.049). Systemic mean arterial pressures were markedly decreased from 81 to 75 mmHg (P = 0.005). Sildenafil did not improve pulmonary arterial oxygen tension, but resulted in a further increase in the shunt fraction.
Although sildenafil reduced pulmonary arterial pressures during ARDS, the increased shunt fraction and decreased arterial oxygenation render it unsuitable for the treatment of patients with ARDS.
肺动脉高压是急性呼吸窘迫综合征（ARDS）的一个特征性表现，并与死亡率相关。在门诊肺动脉高压患者中应用西地那非可改善氧合并减轻肺动脉高压。我们的目的是确定西地那非是否对 ARDS 患者有益。
前瞻性、开放标签、多中心、干预性队列研究。
两家大学医院的内科-外科重症监护病房。
10 例连续符合 NAECC ARDS 标准的患者。
通过鼻胃管给予单剂量 50mg 西地那非枸橼酸盐。
在 ARDS 患者中应用西地那非使平均肺动脉压从 25mmHg 降至 22mmHg（P=0.022），肺动脉闭塞压从 16mmHg 降至 13mmHg（P=0.049）。全身平均动脉压明显从 81mmHg 降至 75mmHg（P=0.005）。西地那非并未改善肺动脉氧分压，但导致分流量进一步增加。
虽然西地那非在 ARDS 期间降低了肺动脉压，但增加的分流量和降低的动脉氧合使它不适合治疗 ARDS 患者。
