Sildenafil in endotoxin-induced pulmonary hypertension: an experimental study

Background: Sepsis and septic shock still represent great challenges in critical care medicine. Sildenafil has been largely used in the treatment of pulmonary arterial hypertension, but its effects in sepsis are unknown. The aim of this study was to investigate the hypothesis that sildenafil can attenuate endotoxin-induced pulmonary hypertension in a porcine model of endotoxemia. Methods: Twenty pigs were randomly assigned to Control group (n = 10), which received saline solution; or to Sildenafil group (n = 10), which received sildenafil orally (100 mg). After 30 min-utes, both groups were submitted to endotoxemia with intravenous bacterial lipopolysaccharide endotoxin (LPS) infusion (4 & mu;g.kg-1.h-1) for 180 minutes. We evaluated hemodynamic and oxy-genation functions, and also lung histology and plasma cytokine (TNFa, IL-1(3, IL6, and IL10) and troponin I response. Results: Significant hemodynamic alterations were observed after 30 minutes of LPS contin-uous infusion, mainly in pulmonary arterial pressure (from Baseline 19 & PLUSMN; 2 mmHg to LPS30 52 & PLUSMN; 4 mmHg, p < 0.05). There was also a significant decrease in PaO2/FiO2 (from Baseline 411 & PLUSMN; 29 to LPS180 334 & PLUSMN; 49, p < 0.05). Pulmonary arterial pressure was significantly lower in the Sildenafil group (35 & PLUSMN; 4 mmHg at LPS30, p < 0.05). The Sildenafil group also presented lower values of systemic arterial pressure. Sildenafil maintained oxygenation with higher PaO2/FiO2 and lower oxygen extraction rate than Control group but had no effect on intrapulmonary shunt. All cytokines and troponin increased after LPS infusion in both groups similarly.Conclusion: Sildenafil attenuated endotoxin-induced pulmonary hypertension preserving the correct heart function without improving lung lesions or inflammation.& COPY; 2021 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).