Fluctuations in cerebral oxygenation and blood volume during endotracheal suctioning in premature infants.

To investigate the effect that suctioning of the endotracheal tube has on the cerebral circulation, we monitored brain intravascular hemoglobin saturation (tHbo2%), cerebral blood volume (CBV), and arterial hemoglobin saturation (Spo2) during suctioning in 12 infants (24 to 33 weeks of gestational age) with respiratory distress syndrome treated with mechanical ventilation. The tHbo2% and CBV values were monitored over the forebrain by dual-wavelength near-infrared spectroscopy, and Spo2 was monitored by pulse oximetry of a finger. The monitored variables were stable during the baseline period. With suctioning, Spo2 decreased from 94% +/- 1% to 84% +/- 1%, tHbo2% decreased, and CBV increased (p less than 0.05). Desaturation in the arterial and cerebral circulations began within 5 seconds of the onset of suctioning. Arterial reoxygenation began with the onset of reventilation, whereas reoxygenation in the brain was delayed by 15 seconds. The Spo2, tHbo2%, and CBV values returned to baseline within 1 minute of reventilation. Studies were repeated in six of the infants after the fraction of inspired oxygen was increased to attain a baseline Spo2 of 100%. In the preoxygenated infants, tHbo2%, CBV, and Spo2 remained constant during suctioning. These studies confirm that endotracheal suctioning results in transient hypoxemia, and demonstrate that this is reflected in the brain by vasodilation and deoxygenation. These effects are preventable by preoxygenation before suctioning.