Sigh in Patients With Acute Hypoxemic Respiratory Failure and ARDS

Abstract

Background Sigh is a cyclic brief recruitment manoeuvre: previous physiological studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity and increase release of surfactant. Research Question Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study Design and Methods We conducted a multi-center non-inferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or acute respiratory distress syndrome undergoing PSV. Patients were randomized to the No Sigh group and treated by PSV alone, or to the Sigh group, treated by PSV plus sigh (increase of airway pressure to 30 cmH 2 Ofor 3 seconds once per minute) until day 28 or death or successful spontaneous breathing trial. The primary endpoint of the study was feasibility, assessed as non-inferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiological parameters in the first week from randomization, 28-day mortality and ventilator-free days. Results Two-hundred fifty-eight patients (31% women; median age 65 [54-75] years) were enrolled. In the Sigh group, 23% of patients failed to remain on assisted ventilation vs. 30% in the No Sigh group (absolute difference -7%, 95%CI -18% to 4%; p=0.015 for non-inferiority). Adverse events occurred in 12% vs. 13% in Sigh vs. No Sigh (p=0.852). Oxygenation was improved while tidal volume, respiratory rate and corrected minute ventilation were lower over the first 7 days from randomization in Sigh vs. No Sigh. There was no significant difference in terms of mortality (16% vs. 21%, p=0.342) and ventilator-free days (22 [7-26] vs. 22 [3-25] days, p=0.300) for Sigh vs. No Sigh. Interpretation Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.

The Association Between Oxygenation Status at 24 h After Diagnosis of Pulmonary Acute Respiratory Distress Syndrome and the 30-Day Mortality among Pediatric Oncological Patients

“…The proportions of sepsis-related ARDS combined with septic shock and MODS were >50 and >80%, respectively ( 8 , 19 , 20 ). In addition, most ARDS reports were focused on adults, especially elderly patients, who had more complications, such as chronic obstructive pulmonary disease, diabetes, chronic cardiac failure, and acute kidney injury ( 2 , 21 ).…”

Recrutamento alveolar com suspiro: impacto na mecânica respiratória e oxigenação de pacientes ventilados mecanicamente

“…Neste aspecto, em um ensaio clínico randomizado realizado por Mauri, et al 17 , que comparou o modo Ventilação por Pressão de Suporte (PSV) e PSV associado a suspiro, não foram encontradas diferenças expressivas em termos de relação PaO 2 /FiO 2 e desfechos clínicos importantes como: tempo de permanência hospitalar, dias de ventilação mecânica e mortalidade. Porém, foi demonstrado ser uma manobra segura, sem eventos adversos e sem danos teciduais.…”

“…Resultados semelhantes foram encontrados por Patroniti et al 11 ao demonstrar que, durante a administração da manobra de recrutamento com suspiros intermitentes, os parâmetros hemodinâmicos não sofreram quaisquer alterações significativas ao longo do estudo. Neste aspecto, Mauri et al 17 também não identificaram alterações hemodinâmicas, presença de barotraumas e arritmias significativas no grupo PSV com Suspiro versus grupo PSV, demonstrando ser uma manobra segura e possível de ser realizada sem prejuízos clínicos.…”

Ten golden rules for individualized mechanical ventilation in acute respiratory distress syndrome

“…These criteria are similar to those discussed for controlled ventilation in ARDS [36] . Concerning the ventilator mode before weaning and extubation, a recent non-inferiority RCT comparing assisted ventilation and assisted ventilation plus sigh maneuver in acute hypoxemic patients concluded that in the sigh group, 23% of patients failed to remain on pressure-control ventilation, whereas 30% of patients in the assisted ventilation group (absolute difference, −7%; 95% CI, −18% to 4%; p = 0.015), demonstrating feasibility in using a sigh maneuver during assisted ventilation [76] .…”

“…In phenotype 2, we suggest using moderate-to-high PEEP levels to improve lung recruitment; rescue therapies can be considered. In phenotype 3, we suggest using current recommendations for typical (non-COVID) ARDS [ [24] , 25 , [26] , [27] , [28] , 29 , [30] , [31] , [32] , [33] , [34] , [35] , 36 , [37] , [38] , [39] , 40 , [41] , [42] , [43] , [44] , [45] , 46 , [47] , [48] , [49] , [50] , [51] , 52 , [53] , [54] , [55] , 56 , [57] , 58 , [59] , [60] , [61] , [62] , [63] , [64] , 65 , [66] , [67] , [68] , 69 , [70] , [71] , [72] , [73] , [74] , [75] , 76 , [77] , [78] , [79] , [80] , [81] , [82] , 83 , 84 , [85] , [86] , 87 , [88] , [89] ,…”