1. Introduction
infection, pulmonary arterial hypertension, coronavirus disease 2019
CORONAVIRUS DISEASE 2019, MUSCLE RELAXATION, INFECTION, PULMONARY ARTERIAL HYPERTENSION, SECONDARY, CORONAVIRUS, SEVERE ACUTE RESPIRATORY SYNDROME
Pulmonary arterial hypertension (PAH) is common in severe coronavirus disease 2019 (COVID-19) and worsens the prognosis. Sildenafil, a phosphodiesterase-5 inhibitor, is approved for PAH treatment but little is known about its efficacy in cases of severe COVID-19 with PAH. This study aimed to investigate the clinical efficacy of sildenafil in patients with severe COVID-19 and PAH. Intensive care unit (ICU) patients were randomly assigned to receive sildenafil or a placebo, with 75 participants in each group. Sildenafil was administered orally at 0.25 mg/kg t.i.d. for one week in a placebo-controlled, double-blind manner as an add-on therapy alongside the patient’s routine treatment. The primary endpoint was one-week mortality, and the secondary endpoints were the one-week intubation rate and duration of ICU stay. The mortality rate was 4% vs. 13.3% (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection promotes the development of pulmonary arterial hypertension (PAH) [Sildenafil is a potent and selective inhibitor of phosphodiesterase-5 (PDE-5), the enzyme that enhances smooth muscle relaxation via the nitric oxide/cyclic guanosine monophosphate (NO/cGMP) pathway [This study aimed to investigate the effect of sildenafil on the course and outcome of severe COVID-19 with PAH.