Background: Intravenous (IV) Sildenafil form may be given intermittently or continuously. This study evaluated if IV continuous sildenafil titration is well tolerated and looked at adverse events and outcomes when used for management of pulmonary hypertension (PH). Methods: Retrospective study (January 1, 2016 - March 31, 2019). Patients ≤18 years of age on IV continuous sildenafil with diagnosis of secondary PH. Change in dose (mg/kg/hr.) and frequency of dose change were collected. Heart rate, blood pressure, and oxygen saturation immediately following the change of dose and echocardiographic data were collected. Primary objective evaluated tolerability. Secondary outcomes: describe titration regimens and clinical outcomes. Clinical characteristics were summarized with descriptive statistics. Continuous variables were reported with medians and categorical variables with frequencies and percentages. Results: The median age and weight were 156 (5-890) days and 4.2 (1.9-12.1) kg, respectively. Median initial and maximum doses of continuous IV sildenafil were 1 mg/k/day (0.4-2.5) and 4 mg/k/day (2-4). The median (range) time of continuous IV sildenafil titration was every 8 (5.7-89.3) hours. Median number of times IV continuous sildenafil was upward titrated was 5 (2-8) times. Hemodynamically important adverse events noted was decrease in blood pressure in 3 subjects (23.1%). A decrease in the estimated right ventricular pressure was noted in 9/11 subjects (81%) Conclusion: According to these data, continuous IV sildenafil appears to be tolerated, but may be associated with hypotension. Further studies are necessary to compare intermittent to continuous IV sildenafil therapy.

Children admitted to the ward for status asthmaticus may not receive the first albuterol treatment on schedule. We sought to determine if a difference in timing between scheduled and actual first dose of albuterol is associated with care escalation to the pediatric intensive care unit (PICU). We conducted a single-center case-control study of children 2-18 years admitted from the emergency department (ED) to the ward for status asthmaticus. Cases required transfer to the PICU within 24 hours of admission. Groups were compared using Fisher’s exact or Mann-Whitney U tests. Firth multivariable logistic regression estimated the association between dose timing and odds of transfer to the PICU. Groups did not differ by demographics, comorbidities, or asthma severity risk factors. The median (IQR) time difference between scheduled and administered first dose of albuterol was 0 (-14 to 63) minutes for cases and 16 (-6 to 42) minutes for controls ( p=.4). Fifty percent of cases received delayed treatment compared to 63% of controls ( p=.28). The adjusted analyses demonstrated that as the time difference between scheduled and administered albuterol increased by 1 minute, odds of care escalation to the PICU remained the same (OR=1.0, 95% CI: 0.9 to 1.0; p=.2). Receiving first albuterol treatment on the ward at a time different than scheduled was not associated with increased odds of transfer to PICU. Delayed albuterol administration did not vary with PICU transfer. Delays in treatment, when taken in the context of evidence-based asthma pathways, did not significantly impact hospital course or quality of care.