Why does suctioning cause increased icp

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. 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. The change in ICP was significantly greater in the fourth pass of catheter insertion than in other passes.

Suction passes should be limited to two to three per procedure. Repeated suctioning may increase ICP. Nurs Res , Gemma M, Tommasino C, et al. J Neurosurg Anesthesiol , Article Google Scholar. These results can be explained by the intense sympathetic stimulation during the end ES maneuver which was probably blocked by sedation and analgesia, not only by lidocaine although some studies have concluded that lidocaine does not attenuate cardiovascular response [ 14 , 15 , 29 , 35 , 36 ].

Nevertheless, Hamaya et al reported that the sympathetic responses mediated by the tactile stimulation of the larynx, tracheal carina and bronchi were completely blocked by ETL and partially blocked by IVL [ 14 ]. The findings were discussed by Grover et al [ 12 ] where it was observed that the prophylactic effect of IVL on a dose of 1.

In our previous practical and clinical analysis, we have noted clinical controversy surrounding administration of lidocaine before ES in patients with brain injury and we have observed that there is no guideline of safety and effectiveness of this practice, arousing controversy over the best route and doses with consequent limitations on the universal implementations.

In our research, it was applied the literature recommended dosage that should be administered in the endotracheal tube or intravenously [ 11 , 13 ].

It was not our intention to compare or question the safety and effectiveness of different doses of lidocaine. It must be observed that our patients had no intracranial hypertension and for ethical reasons and based on current literature we had no group without lidocaine if patients was under increased ICP.

Clearly, no acute deterioration was observed with any of the three regimens but, in theory, secondary brain injury caused by global or localized cerebral ischemia is certainly possible when CPP decreases followed by an increase in ICP that was avoided in lidocaine groups.

It is important that the medical team play a significant role in critically evaluating the use of medication and procedures in the management of patients in critical states in special severe head injury. According to our preliminary data from prospective pilot study, the use of lidocaine administered intravenously or endotracheally can prevent ICP changes during routine endotracheal suctioning by tube.

Either endotracheal or intravenous lidocaine was completely successful in preventing a rise in ICP. Aiming for patient safety we propose the use of endotracheal lidocaine because ETL can be used as safely as IVL, as long as plasma levels of lidocaine are outside the range of toxicities and intravenous drugs have a heightened risk of causing significant patient harm when used in error and preventable adverse drug events, are a quality and cost issue in healthcare [ 37 - 39 ].

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Original Article Volume 3, Number 2, April , pages Click for large image. Figure 1. Intracranial Pressure pre and post Lidocaine administration.

Moreira, Ana Paula D. Eiras Falcao. Abstract Background: In patients with severe head injury, endotracheal suctioning ES is a potentially unsafe procedure, because it can increase intracranial pressure ICP and decrease cerebral perfusion pressure CPP. Lidocaine has been shown to directly blunt ICP rises before ES, although it is not known whether the efficacy of lidocaine given endotracheally is comparable with that intravenously. The purpose of this study was evaluated the effects of ES on ICP with or without the use of lidocaine given endotracheally or intravenously in head trauma.

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