OBJECTIVE: The purpose of the study was to assess mortality in an infant population receiving sildenafil. METHODS: A retrospective review of hospitalized infants at Children's Hospital Los Angeles who received sildenafil between 2008 and 2012 was conducted. Patient characteristics, comorbidities, and treatment characteristics were analyzed. Primary outcome was mortality at discharge. Sildenafil dosage ranges were based on the Sildenafil in Treatment-Naïve Children, Aged 1-17 Years, With Pulmonary Arterial Hypertension trial and were categorized as small (<1.5 mg/kg/day), medium (1.5-3.75 mg/kg/day), large (3.76-7.5 mg/kg/day), and very large (>7.5 mg/kg/day). RESULTS: A total of 147 infants were studied. A total of 82% of patients had severe pulmonary hypertension. Our data revealed 29% mortality at discharge. Mortality increased with increasing sildenafil dosage: 14% (small), 19% (medium), 49% (large), and 90% (very large). On multivariate analysis of sildenafil dosage, other pulmonary hypertension therapies, presence of persistent cardiac shunts, and duration of sildenafil, odds of dying were significantly higher with combined high and very high sildenafil dosage groups compared with combined low and medium dosage groups (OR, 13.2; CI, 4.4-39.5; p < 0.0001). CONCLUSION: Sildenafil was given to critically ill infants with multiple risk factors for mortality. Although higher doses cannot be causally related to mortality, there appears to be no added benefit by escalating the sildenafil dose.
OBJECTIVE: The purpose of the study was to assess mortality in an infant population receiving sildenafil. METHODS: A retrospective review of hospitalized infants at Children's Hospital Los Angeles who received sildenafil between 2008 and 2012 was conducted. Patient characteristics, comorbidities, and treatment characteristics were analyzed. Primary outcome was mortality at discharge. Sildenafil dosage ranges were based on the Sildenafil in Treatment-Naïve Children, Aged 1-17 Years, With Pulmonary Arterial Hypertension trial and were categorized as small (<1.5 mg/kg/day), medium (1.5-3.75 mg/kg/day), large (3.76-7.5 mg/kg/day), and very large (>7.5 mg/kg/day). RESULTS: A total of 147 infants were studied. A total of 82% of patients had severe pulmonary hypertension. Our data revealed 29% mortality at discharge. Mortality increased with increasing sildenafil dosage: 14% (small), 19% (medium), 49% (large), and 90% (very large). On multivariate analysis of sildenafil dosage, other pulmonary hypertension therapies, presence of persistent cardiac shunts, and duration of sildenafil, odds of dying were significantly higher with combined high and very high sildenafil dosage groups compared with combined low and medium dosage groups (OR, 13.2; CI, 4.4-39.5; p < 0.0001). CONCLUSION:Sildenafil was given to critically ill infants with multiple risk factors for mortality. Although higher doses cannot be causally related to mortality, there appears to be no added benefit by escalating the sildenafil dose.
Authors: Robyn J Barst; Maurice Beghetti; Tomas Pulido; Gary Layton; Irina Konourina; Min Zhang; D Dunbar Ivy Journal: Circulation Date: 2014-03-17 Impact factor: 29.690
Authors: Raed A Dweik; Sharon Rounds; Serpil C Erzurum; Stephen Archer; Karen Fagan; Paul M Hassoun; Nicholas S Hill; Marc Humbert; Steven M Kawut; Michael Krowka; Evangelos Michelakis; Nicholas W Morrell; Kurt Stenmark; Rubin M Tuder; John Newman Journal: Am J Respir Crit Care Med Date: 2014-02-01 Impact factor: 21.405
Authors: Robyn J Barst; D Dunbar Ivy; Guillermo Gaitan; Andras Szatmari; Andrzej Rudzinski; Alberto E Garcia; B K S Sastry; Tomas Pulido; Gary R Layton; Marjana Serdarevic-Pehar; David L Wessel Journal: Circulation Date: 2011-11-29 Impact factor: 29.690
Authors: Maria Jesus Del Cerro; Steven Abman; Gabriel Diaz; Alexandra Heath Freudenthal; Franz Freudenthal; S Harikrishnan; Sheila G Haworth; Dunbar Ivy; Antonio A Lopes; J Usha Raj; Julio Sandoval; Kurt Stenmark; Ian Adatia Journal: Pulm Circ Date: 2011 Impact factor: 3.017