Skip to main content
Critical Care logoLink to Critical Care
. 2009 Mar 13;13(Suppl 1):P80. doi: 10.1186/cc7244

Effect of endotracheal suctioning on intracranial pressure in severe head-injured patients

S Gholamzadeh 1, M Javadi 1
PMCID: PMC4083966

Introduction

Endotracheal suctioning (ETS) is a routine nursing procedure used to decrease pulmonary complications; however, in severe head-injured patients it can result in a sudden increase in intracranial pressure (ICP) and may put the patient at risk for further cerebral damage [1-3]. The purpose of this study was to examine the effect of ETS on ICP in severe head-injured patients.

Methods

Twenty-one patients with acute severe head injury (Glasgow coma score ≤ 8, range 4 to 8) were studied. Each subject received four passes of insertion of a standardized suction catheter and application of negative pressure limited to 10 to 15 seconds in each procedure of suctioning. The ETS procedure consisted of administration of 16 breaths at 135% of the patients' tidal volume, 100% FIO2 before and after suctioning with a standardized catheter (16 French) and duration between 10 and 15 seconds. A repeated-measures model for ANOVA was used to examine the changes in mean ICP 1 min before and during the first, second, third and fourth passes of catheter insertion.

Results

ICP significantly increased during suctioning (P < 0.001). The change in ICP was significantly greater in the fourth pass of catheter insertion than in other passes.

Conclusion

Changes in ICP induced by ETS in severe head-injured patients are significant. Suction passes should be limited to two to three per procedure. Repeated suctioning may increase ICP.

References

  1. Kerr ME, Rudy EB. et al. Effect of short-duration hyperventilation during endotracheal suctioning on intracranial pressure in severe head-injured adults. Nurs Res. 1997;13:195–201. doi: 10.1097/00006199-199707000-00003. [DOI] [PubMed] [Google Scholar]
  2. Gemma M, Tommasino C. et al. Intracranial effects of endotracheal suctioning in the acute phase of head injury. J Neurosurg Anesthesiol. 2002;13:50–54. doi: 10.1097/00008506-200201000-00010. [DOI] [PubMed] [Google Scholar]
  3. Rudy EB, Turner BS, Baun M. et al. Endotracheal suctioning in adults with head injury. Heart Lung. 1991;13:667–674. [PubMed] [Google Scholar]

Articles from Critical Care are provided here courtesy of BMC

RESOURCES