ArticleCritical care (London, England)2019
Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation.
Article in Critical care (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04924920 (Sigh35 and End-expiratory Occlusion Test), which is not on this map. Cited by 17 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Sigh35 and End-expiratory Occlusion Test (EEOT) for Assessing flUid Responsiveness in Critically Ill Patients Undergoing Pressure Support Ventilation
Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- ESICM guidelines on circulatory shock and hemodynamic monitoring 2025.Intensive care medicine · 2025Guideline
- Fluid challenge in critically ill patients receiving haemodynamic monitoring: a systematic review and comparison of two decades.Critical care (London, England) · 2022Pooled it
- Can carotid artery Doppler variations induced by the end-expiratory occlusion maneuver predict fluid responsiveness in septic shock patients?Critical care (London, England) · 2023Trial
- Fluid therapy in adults having non-cardiac surgery: A narrative review.Annals of intensive care · 2026Review
- Assessing fluid responsiveness by using functional hemodynamic tests in critically ill patients: a narrative review and a profile-based clinical guide.Journal of clinical monitoring and computing · 2025Review
- SIGHCritical care (London, England) · 2025Article
- Using the ventilator to predict fluid responsiveness.Intensive care medicine · 2025Article
- The effect of passive leg raising test on intracranial pressure and cerebral autoregulation in brain injured patients: a physiological observational study.Critical care (London, England) · 2024Observational
- Carotid blood flow changes following a simulated end-inspiratory occlusion maneuver measured by ultrasound can predict hypotension after the induction of general anesthesia: an observational study.BMC anesthesiology · 2024Observational
- How I personalize fluid therapy in septic shock?Critical care (London, England) · 2023Review
- How can assessing hemodynamics help to assess volume status?Intensive care medicine · 2022Review
- Variations of pulse pressure and central venous pressure may predict fluid responsiveness in mechanically ventilated patients during lung recruitment manoeuvre: an ancillary study.BMC anesthesiology · 2022Article
- Prediction of fluid responsiveness. What's new?Annals of intensive care · 2022Review
- Slope analysis for the prediction of fluid responsiveness by a stepwise PEEP elevation recruitment maneuver in mechanically ventilated patients.BMC anesthesiology · 2022Observational
- Should high-flow through nasal cannula be used during bronchoscopy in critically ill patients with hypoxemic acute respiratory failure?Journal of anesthesia, analgesia and critical care · 2021Review
- Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?Journal of anesthesia · 2020Review
- Letter on "Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation".Critical care (London, England) · 2019Article
Corrections and comments
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Authors and funding
11 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAssessment of fluid responsiveness is problematic in intensive care unit (ICU) patients, in particular for those undergoing modes of partial support, such as pressure support ventilation (PSV). We propose a new test, based on application of a ventilator-generated sigh, to predict fluid responsiveness in ICU patients undergoing PSV.
methodsThis was a prospective bi-centric interventional study conducted in two general ICUs. In 40 critically ill patients with a stable ventilatory PSV pattern and requiring volume expansion (VE), we assessed the variations in arterial systolic pressure (SAP), pulse pressure (PP) and stroke volume index (SVI) consequent to random application of 4-s sighs at three different inspiratory pressures. A radial arterial signal was directed to the MOSTCARE™ pulse contour hemodynamic monitoring system for hemodynamic measurements. Data obtained during sigh tests were recorded beat by beat, while all the hemodynamic parameters were averaged over 30 s for the remaining period of the study protocol. VE consisted of 500 mL of crystalloids over 10 min. A patient was considered a responder if a VE-induced increase in cardiac index (CI) ≥ 15% was observed.
resultsThe slopes for SAP, SVI and PP of were all significantly different between responders and non-responders (p < 0.0001, p = 0.0004 and p < 0.0001, respectively). The AUC of the slope of SAP (0.99; sensitivity 100.0% (79.4-100.0%) and specificity 95.8% (78.8-99.9%) was significantly greater than the AUC for PP (0.91) and SVI (0.83) (p = 0.04 and 0.009, respectively). The SAP slope best threshold value of the ROC curve was - 4.4° from baseline. The only parameter found to be independently associated with fluid responsiveness among those included in the logistic regression was the slope for SAP (p = 0.009; odds ratio 0.27 (95% confidence interval (CI
conclusionsIn a selected ICU population undergoing PSV, analysis of the slope for SAP after the application of three successive sighs and the nadir of PP after Sigh
trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12615001232527 . Registered on 10 November 2015.
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