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Intermittent sigh breaths during high-frequency oscillatory ventilation in preterm infants: a randomised crossover

Judith Leigh Hough1,2,3, Luke Jardine4,5, Matthew James Hough6

  • 1School of Allied Health, Australian Catholic University Faculty of Health Sciences, Banyo, Queensland, Australia judyhough@hotmail.com.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|October 15, 2024
PubMed

Insights

Adding sigh breaths to high-frequency oscillatory ventilation (HFOV) improved lung volume and oxygenation in preterm infants. This short-term intervention enhanced end-expiratory lung volume (EELV) and oxygen saturation in vulnerable newborns.

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Care
  • Critical Care Medicine

Background:

  • Preterm infants often require mechanical ventilation, with high-frequency oscillatory ventilation (HFOV) being a common mode.
  • Maintaining adequate end-expiratory lung volume (EELV) and oxygenation is crucial for improving outcomes in these vulnerable patients.
  • Conventional HFOV may not always ensure optimal lung recruitment and gas exchange.

Purpose of the Study:

  • To investigate the efficacy of combining HFOV with intermittent sigh breaths.
  • To assess the impact of this combined approach on EELV and oxygenation in preterm infants.
  • To determine if sigh breaths enhance lung volume distribution during HFOV.

Main Methods:

  • A prospective interventional crossover study was conducted in a neonatal intensive care unit.
  • Ventilated preterm infants (<36 weeks corrected gestational age) receiving HFOV were randomly assigned to HFOV with sigh breaths or HFOV alone.
  • Electrical impedance tomography (EIT) was used to measure EELV and ventilation distribution, with physiological variables recorded to assess oxygenation.

Main Results:

  • The addition of sigh breaths to HFOV significantly increased global EELV (p=0.04).
  • Ventilation distribution improved, with increased aeration in the posterior and left lung segments.
  • Oxygen saturations showed a significant improvement (p<0.01) with the addition of sigh breaths.

Conclusions:

  • Intermittent sigh breaths during HFOV are associated with short-term improvements in EELV.
  • This strategy enhances lung aeration in dependent and left lung regions.
  • The combination of HFOV and sigh breaths leads to improved oxygenation in preterm infants.
Abstract

Keywords:
intensive care units, neonatalneonatology

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