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In the child with pulmonary hypertension, does treatment with enteral sildenafil compared with a slow wean from nitric oxide alone prevent rebound pulmonary hypertension and allow for discontinuation of nitric oxide?
  1. Seana Molloy1,
  2. Steven McVea2,
  3. Andrew Thompson1,
  4. Thomas Bourke3
  1. 1Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2Paediatric Intensive Care, Royal Hospital for Children Glasgow, Glasgow, UK
  3. 3School of medicine, dentistry and biomedical sciences, Queens University, Belfast, UK
  1. Correspondence to Dr Seana Molloy, Paediatrics, Royal Belfast Hospital for Sick Children, Belfast BT12 6BA, UK; seana.molloy{at}belfasttrust.hscni.net

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Clinical bottom line

  • Enteral sildenafil reduced the incidence of rebound pulmonary hypertension in children (GRADE B).

  • Assisting weaning, sildenafil may facilitate reduced duration of mechanical ventilation and intensive care unit stay (GRADE B).

Scenario

An 8-week-old infant is receiving inhaled nitric oxide (iNO) for secondary pulmonary hypertension (PHT) in paediatric intensive care unit (PICU). The child is postcongenital diaphragmatic hernia repair and is proving difficult to wean from iNO. Given the problem with rebound PHT, you wonder if treatment with enteral sildenafil will aid discontinuation of iNO.

Structured clinical question

In the child with pulmonary hypertension (population), does treatment with enteral sildenafil (intervention) compared with a slow wean from iNO alone (comparison) prevent rebound PHT and allow for discontinuation of iNO (outcome)?

Search

We performed an online search using PubMed and Medline (1946 to present) in September 2019. The key terms were (pulmonary hypertension) AND (rebound) AND (sildenafil) AND (nitric oxide) AND (child). We limited the search to include articles written in English. We identified three relevant articles, a randomised controlled trial, a prospective and a retrospective …

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