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

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.