BACKGROUND: SARS-CoV-2 seems to affect the regulation of pulmonary perfusion. Hypoperfusion in areas of well-aerated lung parenchyma results in a ventilation-perfusion mismatch that can be characterized using subtraction computed tomography angiography (sCTA). This study aims to evaluate the efficacy of oral sildenafil in treating COVID-19 inpatients showing perfusion abnormalities in sCTA. METHODS: Triple-blinded, randomized, placebo-controlled trial was conducted in Chile in a tertiary-care hospital able to provide on-site sCTA scans and ventilatory support when needed between August 2020 and March 2021. In total, 82 eligible adults were admitted to the ED with RT-PCR-confirmed or highly probable SARS-COV-2 infection and sCTA performed within 24 h of admission showing perfusion abnormalities in areas of well-aerated lung parenchyma; 42 were excluded and 40 participants were enrolled and randomized (1:1 ratio) once hospitalized. The active intervention group received sildenafil (25 mg orally three times a day for seven days), and the control group received identical placebo capsules in the same way. Primary outcomes were differences in oxygenation parameters measured daily during follow-up (PaO2/FiO2 ratio and A-a gradient). Secondary outcomes included admission to the ICU, requirement of non-invasive ventilation, invasive mechanical ventilation (IMV), and mortality rates. Analysis was performed on an intention-to-treat basis. RESULTS: Totally, 40 participants were enrolled (20 in the placebo group and 20 in the sildenafil group); 33 [82.5%] were male; and median age was 57 [IQR 41-68] years. No significant differences in mean PaO2/FiO2 ratios and A-a gradients were found between groups (repeated-measures ANOVA p = 0.67 and p = 0.69). IMV was required in 4 patients who received placebo and none in the sildenafil arm (logrank p = 0.04). Patients in the sildenafil arm showed a significantly shorter median length of hospital stay than the placebo group (9 IQR 7-12 days vs. 12 IQR 9-21 days, p = 0.04). CONCLUSIONS: No statistically significant differences were found in the oxygenation parameters. Sildenafil treatment could have a potential therapeutic role regarding the need for IMV in COVID-19 patients with specific perfusion patterns in sCTA. A large-scale study is needed to confirm these results. TRIAL REGISTRATION: Sildenafil for treating patients with COVID-19 and perfusion mismatch: a pilot randomized trial, NCT04489446, Registered 28 July 2020, https://clinicaltrials.gov/ct2/show/NCT04489446 .
COVID-19 Drug Treatment , COVID-19 , Sildenafil Citrate , Vasodilator Agents , Administration, Oral , Adult , Aged , COVID-19/physiopathology , Female , Humans , Male , Middle Aged , Pilot Projects , Sildenafil Citrate/administration & dosage , Treatment Outcome , Vasodilator Agents/administration & dosage , Ventilation-Perfusion Ratio
La implantación de marcapaso definitivo (MPD) se realiza en portadores de alteraciones en la generación del impulso eléctrico del corazón y/o con trastornos de la conducción. Las guías clínicas para su manejo proponen un seguimiento precoz, regular y de por vida, posterior al implante de MPD, con el fin de pesquisar alteraciones. Objetivo: caracterizar y evaluar adherencia a seguimiento en pacientes con primoimplante de MPD del Hospital Gustavo Fricke (HGF) en el período 2007. Pacientes y método: estudio descriptivo y retrospectivo, cuyo universo fueron los pacientes con primoimplante de MPD del HGF en el año 2007. Se caracterizaron los pacientes de acuerdo a sexo, edad y diagnóstico de indicación de MPD; se describió el porcentaje de inasistencia al primer, segundo y tercer control post-implante del MPD (correspondiente por garantías explícitas en salud) y finalmente se buscaron causas de inasistencia a estos controles. Resultados: el universo fue de 181 pacientes, 101 hombres. El grupo etáreo predominante fueron mayores de 70 años (56,9 por ciento). Los diagnósticos más frecuentes fueron: bloqueo auriculoventricular completo (31,4 por ciento) y enfermedad del nodo sinusal (30,9 por ciento). De los 181 pacientes del universo, 110 faltaron al menos a un control con una curva de insistencia ascendente en el tiempo, observándose que a los 6 meses (tercer control) más de la mitad estuvo inasistente. De estos 110 pacientes, 60 pudieron ser contactados telefónicamente para aplicarles una encuesta de causas de inasistencia, encontrándose que 37 de ellos no asistieron a control por falta de citación. La caracterización de pacientes respecto a sexo, edad y diagnóstico de indicación de MPD coincidió con la literatura. Conclusiones: el importante ascenso de las inasistencias a controles post-implante de MPD contrasta con las recomendaciones de seguimiento.
The difinitive pacemaker (DPM) implantation is performed in patients with alterations in the generation of electrical impulse from heart and / or conduction disturbances. Clinical guidelines for management proposed early tracking, regular and for life, post DPM implantation in order to detect alterations. Aim: characterize and assess adherence to monitoring in patients with first DPM implantation at the Hospital Gustavo Fricke (HGF) during 2007. Method and patients: retrospective and descriptive study. The universe were patients with first DPM implantation at HGF during 2007. Patients were characterized according to sex, age and diagnosis of DPM indication; percentage of absence at the first, second and third control post DPM implantation (corresponding to clinical guidelines in Chile) was described and finally causes of absences to the controls were investigated. Results: the universe was 181 patients; 101 men. The most frequent age group were older than 70 years (56.9 percent). The most common diagnoses were: complete atrioventricular block (31.4 percent) and sinus node disease (30.9 percent). Of 181 patients of the universe, 110 missed at least one control in an ascending curve in time so that at 6 months (third control) more of 50 percent did not attend the medical control. Of these 110 patients, 60 could be contacted to make a telephone poll to know the causes of the absence and it was found that 37 of them did not attend due to lack of appointment. Characterization of patients regarding sex, age and diagnosis of DPM indication coincided broadly with those reported in the literature. Conclusions: the significant rise in absences to post implantation DPM controls contrasts sharply with the follow-up recommendations.
Humans , Male , Female , Middle Aged , Pacemaker, Artificial/adverse effects , Appointments and Schedules , Chile
