Dramatic beneficial effects of sildenafil in recurrent massive pulmonary embolism

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 mg of sildenafil, cardiac index increased from 2.1 l/min/m(2) to 3.2 l/min/m(2); mean pulmonary artery pressure decreased from 56 mmHg to 46 mmHg, and pulmonary vascular resistance index decreased from 700 dynes/cm(-5)/m(2) to 425 dynes/cm(-5)/m(2), without reduction of arterial systemic pressure. Clinical condition also improved during the following days under treatment of 50 mg sildenafil three times daily. Conclusions: These observations should stimulate studies with sildenafil in the ICU setting. Sildenafil 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.