{"id":24912,"date":"2023-11-01T04:25:00","date_gmt":"2023-10-31T20:25:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=24912"},"modified":"2023-11-01T05:36:31","modified_gmt":"2023-10-31T21:36:31","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%88%9b%e4%bc%a4%e6%82%a3%e8%80%85%e7%9a%84%e5%8f%b9%e6%b0%94%e9%80%9a%e6%b0%94","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24912","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u521b\u4f24\u60a3\u8005\u7684\u53f9\u6c14\u901a\u6c14"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

October 25, 2023<\/p>\n\n\n\n

Sigh Ventilation in Patients With Trauma: The SiVent Randomized Clinical Trial<\/h1>\n\n\n\n

Richard K.\u00a0Albert,\u00a0Gregory J.\u00a0Jurkovich,\u00a0John\u00a0Connett,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online October 25, 2023. doi:10.1001\/jama.2023.21739<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Does adding sigh breaths to the usual care of trauma patients receiving mechanical ventilation increase ventilator-free days?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial among 524 trauma patients with risk factors for developing acute respiratory distress syndrome, the addition of sigh breaths did not significantly increase ventilator-free days compared with usual care alone (median ventilator-free days, 18.4 vs 16.1, respectively). Although not adjusted for multiple testing, sigh breaths were associated with improvement in secondary outcomes including all-cause mortality. There was no evidence of harm.<\/p>\n\n\n\n

Meaning<\/strong>  Sigh breaths added to usual care did not significantly increase ventilator-free days among trauma patients who received mechanical ventilation but may improve clinical outcomes.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by altering or depleting surfactant. The role of sigh breaths in reducing ventilator-induced lung injury among trauma patients at risk of poor outcomes is unknown.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether adding sigh breaths improves clinical outcomes.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  A pragmatic, randomized trial of sigh breaths plus usual care conducted from 2016 to 2022 with 28-day follow-up in 15 academic trauma centers in the US. Inclusion criteria were age older than 18 years, mechanical ventilation because of trauma for less than 24 hours, 1 or more of 5 risk factors for developing acute respiratory distress syndrome, expected duration of ventilation longer than 24 hours, and predicted survival longer than 48 hours.<\/p>\n\n\n\n

Interventions<\/strong>  Sigh volumes producing plateau pressures of 35 cm H2<\/sub>O (or 40 cm H2<\/sub>O for inpatients with body mass indexes >35) delivered once every 6 minutes. Usual care was defined as the patient\u2019s physician(s) treating the patient as they wished.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was ventilator-free days. Prespecified secondary outcomes included all-cause 28-day mortality.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of 5753 patients screened, 524 were enrolled (mean [SD] age, 43.9 [19.2] years; 394 [75.2%] were male). The median ventilator-free days was 18.4 (IQR, 7.0-25.2) in patients randomized to sighs and 16.1 (IQR, 1.1-24.4) in those receiving usual care alone (P<\/em>\u2009=\u2009.08). The unadjusted mean difference in ventilator-free days between groups was 1.9 days (95% CI, 0.1 to 3.6) and the prespecified adjusted mean difference was 1.4 days (95% CI, \u22120.2 to 3.0). For the prespecified secondary outcome, patients randomized to sighs had 28-day mortality of 11.6% (30\/259) vs 17.6% (46\/261) in those receiving usual care (P<\/em>\u2009=\u2009.05). No differences were observed in nonfatal adverse events comparing patients with sighs (80\/259 [30.9%]) vs those without (80\/261 [30.7%]).<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>  In a pragmatic, randomized trial among trauma patients receiving mechanical ventilation with risk factors for developing acute respiratory distress syndrome, the addition of sigh breaths did not significantly increase ventilator-free days. Prespecified secondary outcome data suggest that sighs are well-tolerated and may improve clinical outcomes.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT02582957<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24912"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24912"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24912\/revisions"}],"predecessor-version":[{"id":24913,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24912\/revisions\/24913"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24912"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24912"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24912"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}