Evidence map›Paper›PMID 39368033›Full record

ArticleAnnals of intensive care2024

Heterogeneous impact of Sighs on mortality in patients with acute hypoxemic respiratory failure: insights from the PROTECTION study.

Emanuele Rezoagli, Carla Fornari, Roberto Fumagalli, Giacomo Grasselli, Carlo Alberto Volta, Paolo Navalesi, Rihard Knafelj, Laurent Brochard, Antonio Pesenti, Tommaso Mauri and 2 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of intensive care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03201263 (PRessure suppOrT vEntilation + Sigh in aCuTe hypoxemIc respiratOry Failure patieNts), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT03201263 nacompletednot on this map

PRessure suppOrT vEntilation + Sigh in aCuTe hypoxemIc respiratOry Failure patieNts (PROTECTION): a Pilot Randomized Controlled Trial

TypeinterventionalSponsorFondazione IRCCS Ca' Granda, Ospedale Maggiore PoliclinicoRan2017 to 2019Enrolled258ConditionsRespiratory Failure, Acute Respiratory Distress Syndrome, Ventilator LungArmsSigh, Standard of care
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Dead space in critical care: a practical approach with clinical scenarios.Journal of anesthesia, analgesia and critical care · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Emanuele RezoagliSchool of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy. emanuele.rezoagli@unimib.it.ORCID http://orcid.org/0000-0002-4506-7212
Carla FornariResearch Centre On Public Health, University of Milano-Bicocca, Monza, Italy.
Roberto FumagalliSchool of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy.
Giacomo GrasselliDepartment of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Carlo Alberto VoltaDepartment of Translational Medicine, University of Ferrara, Ferrara, Italy.
Paolo NavalesiInstitute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy.
Rihard KnafeljCenter for Internal Intensive Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia.
Laurent BrochardInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Antonio PesentiDepartment of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Tommaso Mauri *Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Giuseppe Foti *School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy.
Pleural Pressure Working Group (PLUG)

Funding

European Society of Intensive Care Medicine ESICM Clinical Research Award 2016Ministero della Salute Current research IRCCS
6 · The paper itself

Abstract

backgroundSigh breaths may impact outcomes in acute hypoxemic respiratory failure (AHRF) during assisted mechanical ventilation. We investigated whether sigh breaths may impact mortality in predefined subgroups of patients enrolled in the PROTECTION multicenter clinical trial according to: 1.the physiological response in oxygenation to Sigh (responders versus non-responders) and 2.the set levels of positive end-expiratory pressure (PEEP) (High vs. Low-PEEP). If mortality differed between Sigh and No Sigh, we explored physiological daily differences at 7-days.

resultsPatients were randomized to pressure support ventilation (PSV) with Sigh (Sigh group) versus PSV with no sigh (No Sigh group). (1) Sighs were not associated with differences in 28-day mortality in responders to baseline sigh-test. Contrarily-in non-responders-56 patients were randomized to Sigh (55%) and 28-day mortality was lower with sighs (17%vs.36%, log-rank p = 0.031). (2) In patients with PEEP > 8cmH

conclusionsAddition of Sigh to PSV could reduce mortality in AHRF non-responder to Sigh and exposed to Low-PEEP. Results in non-responders were not expected. Findings in the low PEEP group may indicate that insufficient PEEP was used or that Low PEEP may be used with Sigh. Sigh may reduce mortality by decreasing physiologic dead space and ventilation intensity and/or optimizing ventilation/perfusion mismatch. CLINICAL

trial registrationClinicalTrials.gov; Identifier: NCT03201263.

Indexed as

Acute hypoxemic respiratory failureExtubationMortalityPressure support ventilationSighVentilatory ratio

Identifiers

PMID39368033
PMCPMC11456003

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.