Effects of Open and Closed Endotracheal Suctioning on Intracranial Pressure and Cerebral Perfusion Pressure in Adult Patients With Severe Brain Injury: A Literature Review.

In neurologically impaired adult patients, endotracheal suctioning is a potentially dangerous nursing procedure because it can increase intracranial pressure (ICP) and decrease cerebral perfusion pressure (CPP). This article presents an overview of the literature relating to the appropriate techniques (open system suctioning and closed system suctioning) for minimizing variability in ICP and CPP. The research used databases such as Medline, CINAHL, Embase, Scopus, Cochrane Library, and TripDataBase. Literature published from January 1, 2002, to August 31, 2013, that involved adult patients was reviewed. The main search strings were obtained using the following keyword combinations: "suction AND intracranial pressure AND cerebrovascular circulation," "brain injuries OR craniocerebral trauma AND suction," and "brain injuries OR craniocerebral trauma AND suction AND intracranial pressure." Fourteen articles were included: two systematic reviews, two prospective nonrandomized studies, two prospective double-blind clinical trials, a crossover single-blind clinical trial, three prospective interventionist case studies, a case-control study, and three observational studies. Although most of the articles show an increased ICP above 20 mm Hg when using open system suctioning (as opposed to closed system suctioning), it is still not clear which technique is best for maintaining CPP. Therefore, further studies are needed to determine the best technique for nursing practice.