{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T02:34:45Z","timestamp":1787884485679,"version":"build-2784847793"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"20","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,11,28]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether adding sigh breaths improves clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Sigh volumes producing plateau pressures of 35 cm H<jats:sub>2<\/jats:sub>O (or 40 cm H<jats:sub>2<\/jats:sub>O for inpatients with body mass indexes &amp;amp;gt;35) delivered once every 6 minutes. Usual care was defined as the patient\u2019s physician(s) treating the patient as they wished.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was ventilator-free days. Prespecified secondary outcomes included all-cause 28-day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 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 (<jats:italic>P<\/jats:italic>\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 (<jats:italic>P<\/jats:italic>\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%]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT02582957\">NCT02582957<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2023.21739","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T12:30:57Z","timestamp":1698237057000},"page":"1982","source":"Crossref","is-referenced-by-count":19,"title":["Sigh Ventilation in Patients With Trauma"],"prefix":"10.1001","volume":"330","author":[{"given":"Richard K.","family":"Albert","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Colorado, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Jurkovich","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, Davis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Connett","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika S.","family":"Helgeson","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Keniston","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Voelker","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Lindberg","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Proper","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Bochicchio","sequence":"additional","affiliation":[{"name":"Department of Surgery, Washington University, St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah M.","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Cain","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Tesoriero","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos V. 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