Beneficial Effects of Active Administration of Sildenafil on Clinical Course and Pharmacoeconomics in the Treatment of Persistent Pulmonary Hypertension After Pediatric Congenital Cardiac Surgery

Abstract

Background: Sildenafil, a phosphodiesterase-5 inhibitor, has been widely used as an effective selective pulmonary vasodilator in the treatment of severe pulmonary hypertension (PH) after congenital cardiac surgery. We explored a new active administration of SIL and assessed its beneficial effects on clinical course and pharmacoeconomics in this comparative cohort.
Methods: Sildenafil was administered at a starting dose of 0.5 mg /kg in the intensive care unit and the dose was increased stepwise to a maximum of 2 mg/kg/every 4 hours. We made a comparison of the two groups; group C (conventional administration) where sildenafil was started via nasogastric tube in the withdrawal from inhaled nitric oxide (iNO) (N=13), and group A (active administration) where SIL was started immediately after the ICU admission by enema (N=13). There were no significant differences in the preoperative patient background between the two groups.
Results: Pulmonary arterial pressure significantly decreased in both groups (p<0.05) with similar degrees of change. Five patients in group C required iNO to treat severe PH crises while none in group A experienced similar symptoms. The duration of mechanical ventilation and ICU stay was significantly reduced in group A compared with group C (p<0.05). Medical costs relating to acute management in ICU and the whole hospital stay were significantly higher in group C than in group A.
Conclusion: Active use of SIL can be a favorable option not only for treatment but also for substantial cost savings to treat persistent PH early after pediatric congenital cardiac surgery.