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


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 [13]. The purpose of this study was to examine the effect of ETS on ICP in severe head-injured patients.


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.


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.


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.


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    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, 46: 195-201. 10.1097/00006199-199707000-00003

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    Gemma M, Tommasino C, et al.: Intracranial effects of endotracheal suctioning in the acute phase of head injury. J Neurosurg Anesthesiol 2002, 14: 50-54. 10.1097/00008506-200201000-00010

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    Rudy EB, Turner BS, Baun M, et al.: Endotracheal suctioning in adults with head injury. Heart Lung 1991, 20: 667-674.

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Gholamzadeh, S., Javadi, M. Effect of endotracheal suctioning on intracranial pressure in severe head-injured patients. Crit Care 13, P80 (2009).

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  • Catheter
  • Tidal Volume
  • Head Injury
  • Intracranial Pressure
  • Pulmonary Complication