Intermittent sigh is rarely used in the ICU during mechanical ventilation. In fact, many trainees do not even know about it! Also, not all ventilator brands can deliver intermittent sigh.
Intermittent sigh is a maneuver of delivering a deep breath once every few minutes. Theoretically, it was practiced under the assumption that it would maintain lung volume, avoid atelectasis, and improve lung compliance. After ARDS network trials showing that low tidal volumes (TV) are lung-protective, intermittent sigh eventually becomes obsolete, given that such high breaths, even once every few minutes or after 6-8 breaths, may cause volutrauma.
But in 2021, Mauri T. et al. showed that it is at least not harmful and can be considered in selected patients with limited, controlled lower-volume. Oxygenation was improved, whereas tidal volume, respiratory rate, and corrected minute ventilation were lower over the first 7 days from randomization in the sigh vs no-sigh group. Though there was no significant difference in terms of mortality and ventilator-free days for the sigh vs no-sigh group.
Albert RK et al. in 2023 reported a potentially favourable reduction in 28-day mortality. As a secondary outcome, patients randomized to sighs had 28-day mortality of 11.6% (30/259) vs 17.6% (46/261).
This may be an area still untapped in 'vent. management' and may need further exploration.
#Mechanical-ventilation
#pulmonary
References:
1. Mauri T, Foti G, Fornari C, et al. Sigh in Patients With Acute Hypoxemic Respiratory Failure and ARDS: The PROTECTION Pilot Randomized Clinical Trial. Chest 2021; 159:1426.
2. Albert RK, Jurkovich GJ, Connett J, et al. Sigh Ventilation in Patients With Trauma: The SiVent Randomized Clinical Trial. JAMA 2023; 330:1982.
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