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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 August;78(8):920-9
Sigh improves gas exchange and respiratory mechanics in children undergoing pressure support after major surgery
Nacoti M. 1, Spagnolli E. 2, Bonanomi E. 2, Barbanti C. 2, Cereda M. 3, Fumagalli R. 4 ✉
1 Department of Anesthesia and Intensive Care, Riuniti Hospital, Bergamo, Italy;
2 Pediatric Intensive Care, Riuniti Hospital, Bergamo, Italy;
3 Department of Anesthesiology and Critical Care, Hospital of University of Pennsylvania, Philadelphia, PA, USA;
4 Department of Perioperative Medicine and Critical Care, S. Gerardo Hospital University of Milano-Bicocca, Milan, Italy
BACKGROUND: Children undergoing major surgery can develop lung de-recruitment and gas exchange impairment in the postoperative period. The aim of this study was to assess the effect of periodic sigh breaths (Sighs) during pressure support ventilation (PSV) on gas exchange and respiratory pattern in children after major surgery.
METHODS: Twenty children were enrolled and received PSV alone and with Sighs in a randomized order. Sighs were administered once per minute by adding to baseline pressure support a pressure controlled breath set at 30 cm H2O of peak airway pressure. At the end of each study period air flow, pressure traces, and compliance of respiratory system, together with hemodynamic parameters and venous and arterial blood gas tensions, were recorded.
RESULTS: PaO2/FiO2 improved from baseline to Sigh group (312.6±137.4 vs. 394.2±127.0; P<0.01) and PaCO2 decreased from baseline to Sigh group (39.3±3.3 vs. 34.3±4.6 mmHg; P<0.001), without any change in minute expiratory volume. Indexed to body weight compliance of respiratory system improved from baseline to Sigh group (0.85±0.35 vs. 1.01±0.30 mL/kg/cm H2O; P<0.01). There were no significant differences between the two groups for the hemodynamic parameters.
CONCLUSION: The addition of one Sigh per minute during PSV in the post-operative period of children that underwent major surgery improved gas exchange and decreased respiratory drive without producing major short-term complications. Further long-term studies are necessary to evaluate the efficacy and safety of Sigh in pediatric patients.