J Brucia1, E Rudy. 1. University of Pittsburgh School of Nursing, Pa, USA.
Abstract
OBJECTIVE: To determine the effect of suction catheter insertion and tracheal stimulation on cerebrovascular and systemic vascular status in adults with severe traumatic brain injury. DESIGN: Quasi-experimental, within-subject design. SETTING: Two university-affiliated critical care units. SUBJECTS: Thirty intubated and mechanically ventilated adults with severe brain injury. The participants' average age was 31 +/- 15 years. OUTCOME MEASURES: Mean intracranial pressure (MICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and heart rate (HR) were measured. INTERVENTION: Endotracheal suction catheter insertion with tracheal stimulation was performed. RESULTS: Suction catheter insertion and tracheal stimulation, isolated from other components of the suctioning procedure, significantly increased MICP, MAP, and CPP. HR was not significantly increased. During the application of negative pressure for actual suctioning, MICP and HR significantly increased, whereas MAP and CPP did not significantly change compared with catheter insertion. CONCLUSION: Tracheal stimulation during suction catheter insertion initiates both cerebrovascular and systemic vascular responses during the suctioning procedure. Study findings suggest that a potentially productive direction for intervention research is to identify ways to minimize airway stimulation during the suctioning procedure.
OBJECTIVE: To determine the effect of suction catheter insertion and tracheal stimulation on cerebrovascular and systemic vascular status in adults with severe traumatic brain injury. DESIGN: Quasi-experimental, within-subject design. SETTING: Two university-affiliated critical care units. SUBJECTS: Thirty intubated and mechanically ventilated adults with severe brain injury. The participants' average age was 31 +/- 15 years. OUTCOME MEASURES: Mean intracranial pressure (MICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and heart rate (HR) were measured. INTERVENTION: Endotracheal suction catheter insertion with tracheal stimulation was performed. RESULTS: Suction catheter insertion and tracheal stimulation, isolated from other components of the suctioning procedure, significantly increased MICP, MAP, and CPP. HR was not significantly increased. During the application of negative pressure for actual suctioning, MICP and HR significantly increased, whereas MAP and CPP did not significantly change compared with catheter insertion. CONCLUSION: Tracheal stimulation during suction catheter insertion initiates both cerebrovascular and systemic vascular responses during the suctioning procedure. Study findings suggest that a potentially productive direction for intervention research is to identify ways to minimize airway stimulation during the suctioning procedure.