Identify the patient who could benefit from sigh breaths.

• A. 60 kg IBW Patient on 350 mL with Pplat 28
• B. 75 kg IBW Patient on 420 mL with Pplat 26
• C. 65 kg IBW Patient on 360 mL with Pplat 27
• D. 70 kg IBW Patient on 400 mL with Pplat 25

Answer: (D)

Sigh breaths act as a recruitment maneuver: they temporarily deliver a larger breath to raise alveolar pressure and help reopen collapsed units, improving oxygenation when there’s atelectasis or poor alveolar recruitment. But they must be used only when there's enough headroom in plateau pressure to avoid overdistention.

Among these patients, all are on protective tidal volumes, and their plateau pressures range from the mid-20s to high-20s. The patient with the lowest plateau pressure has the most room to tolerate a larger breath without pushing pressures into a dangerous range. That patient is the one with a tidal volume of 400 mL and a plateau pressure of 25 cmH2O. They have the safest margin to perform a recruitment sigh, making them the best candidate for this maneuver.