Use of sildenafil to facilitate weaning from inhaled nitric oxide in children with pulmonary hypertension following surgery for congenital heart disease.

Pulmonary hypertension frequently complicates the postoperative management of patients after congenital cardiac surgery. Inhaled nitric oxide is an effective treatment option, but rebound pulmonary hypertension can occur upon its withdrawal. Sildenafil may facilitate its withdrawal by restoring cyclic guanosine monophosphate availability via phosphodiesterase-5 inhibition. The purpose of this study was to evaluate the use of sildenafil in facilitating weaning from inhaled nitric oxide after congenital cardiac surgery in patients who had previously failed weaning, and to compare the effects of sildenafil on pulmonary and systemic hemodynamics. Children who received sildenafil after cardiovascular surgery during a 23-month period at Riley Hospital for Children were identified. Medical records were retrospectively reviewed to determine sildenafil and nitric oxide dosing, pulmonary and systemic blood pressures, and adverse effects. Oral sildenafil was administered to 7 children who had failed attempts at inhaled nitric oxide weaning. Inhaled nitric oxide was weaned from 29.8+/-5.9 ppm prior to sildenafil initiation to 12.2+/-3.4 ppm (mean +/- SE; P= .024) in the 24 hours after sildenafil. Mean pulmonary artery and systemic arterial pressure were unchanged from baseline when measured 1 hour after sildenafil dosing (mean pulmonary artery pressure, 29+/-1 to 27+/-0.7 mm Hg, P= .066; mean systemic arterial pressure, 56+/-1.2 to 54+/-1.2 mm Hg, P= .202). Sildenafil may facilitate withdrawal of inhaled nitric oxide and prevent rebound pulmonary hypertension in patients previously failing inhaled nitric oxide weaning attempts.

Y-site compatibility of medications with parenteral nutrition.

Providing parenteral nutrition to pediatric patients requiring various other intravenous products can be challenging. Evaluation of compatibility is essential; however, information is limited and sometimes conflicting. We strove to critically evaluate and present the available published data as a comprehensive and practical reference. To accomplish this, we weighed the strength of evidence supporting compatibility versus incompatibility and provided specific conditions affecting compatibility, where appropriate. Many commonly used medications in pediatric patients have consistently demonstrated Y-site compatibility with parenteral nutrition and may be safely administered simultaneously. Exceptions must be noted and these medications should preferentially be administered through a separate line, if available, or the same line may be used only after stopping the parenteral nutrition infusion and flushing the line before and after drug administration.