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Intermittent sigh breaths during high-frequency oscillatory ventilation in preterm infants: a randomised crossover study
  1. Judith Leigh Hough1,2,3,
  2. Luke Jardine4,5,
  3. Matthew James Hough6,
  4. Michael Steele1,
  5. Gorm Greisen7,8,
  6. Christian Heiring8
  1. 1 School of Allied Health, Australian Catholic University Faculty of Health Sciences, Banyo, Queensland, Australia
  2. 2 Department of Physiotherapy, Mater Health Services Brisbane, South Brisbane, Queensland, Australia
  3. 3 Child Health Research Centre, The University of Queensland, St Lucia, Queensland, Australia
  4. 4 School of Clinical Medicine, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
  5. 5 Neonatal Critical Care Unit, Mater Health Services Brisbane, South Brisbane, Queensland, Australia
  6. 6 Department of Combinatorics and Optimization, University of Waterloo, Waterloo, Ontario, Canada
  7. 7 Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
  8. 8 Neonatal and Pediatric Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Judith Leigh Hough; judyhough{at}hotmail.com

Abstract

Objective To determine if combining high-frequency oscillatory ventilation (HFOV) with additional sigh breaths would improve end-expiratory lung volume (EELV) and oxygenation in preterm infants.

Design Prospective interventional crossover study.

Setting Neonatal intensive care unit.

Patients Ventilated preterm infants <36 weeks corrected gestational age receiving HFOV.

Interventions Infants were randomly assigned to receive HFOV with sigh breaths followed by HFOV-only (or vice versa) for four alternating periods. Sigh breaths were delivered with an inspiratory time of 1 s, peak inspiratory pressure of 30 cmH20 and frequency of three breaths/min.

Main outcome measures Electrical impedance tomography measured the effect of sigh breaths on EELV and ventilation distribution. Physiological variables were recorded to monitor oxygenation. Measurements were taken at 30 and 60 min postchange of HFOV mode and compared with baseline.

Results Sixteen infants (10 males, 6 females) with a median (range) gestational age at birth of 25.5 weeks (23–31), study weight of 950 g (660–1920) and a postnatal age of 25 days (3–49) were included in the study. The addition of sigh breaths resulted in a significantly higher global EELV (mean difference±95% CI) (0.06±0.05; p=0.04), with increased ventilation occurring in the posterior (dependent) and left lung segments, and improved oxygen saturations (3.31±2.10; p<0.01).

Conclusion Intermittent sigh breaths during HFOV were associated in the short-term with an increased EELV in the posterior and left lungs, and improved oxygen saturations in preterm infants.

  • intensive care units, neonatal
  • neonatology

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • X @JudyHough5

  • Contributors CH, LJ, JLH conceived and planned the experiments. JLH, CH, LJ coordinated data collection. MJH, MS, JLH analysed the data. JLH, CH, GG, LJ, MS contributed to the interpretation of the results. JLH took the lead in writing the manuscript. All authors provided critical feedback and helped shape the research, analysis and manuscript. JLH is the guarantor.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.