Sigh Ventilation in Patients With Trauma: The SiVent Randomized Clinical Trial

Area of Science:

• Critical Care Medicine
• Pulmonary Medicine
• Trauma Surgery

Background:

• Mechanical ventilation can cause lung injury due to constant tidal volumes, potentially depleting surfactant.
• The benefit of sigh breaths in mitigating ventilator-induced lung injury (VILI) in trauma patients is not well-established.

Purpose of the Study:

• To investigate whether incorporating sigh breaths into mechanical ventilation improves clinical outcomes for trauma patients.
• To assess the impact of sigh breaths on ventilator-free days and 28-day mortality.

Main Methods:

• A pragmatic, randomized trial involving 524 trauma patients requiring mechanical ventilation across 15 US academic centers.
• Patients received either usual care or usual care plus sigh breaths (once every 6 minutes) targeting specific plateau pressures.
• Outcomes were assessed over a 28-day follow-up period, with ventilator-free days as the primary endpoint.

Main Results:

• The median ventilator-free days did not significantly differ between the sigh breath group (18.4 days) and the usual care group (16.1 days) (P=0.08).
• A trend towards improved clinical outcomes was observed, with a lower 28-day mortality in the sigh breath group (11.6%) compared to the usual care group (17.6%) (P=0.05).
• No significant differences in nonfatal adverse events were noted between the groups.

Conclusions:

• The addition of sigh breaths to mechanical ventilation did not significantly increase ventilator-free days in this cohort of trauma patients.
• Sigh breaths were found to be well-tolerated and suggested a potential benefit in improving clinical outcomes, warranting further investigation.