Intracranial Effects of Endotracheal Suctioning in the Acute Phase of Head Injury

Gemma, Marco; Tommasino, Concezione; Cerri, Marco; Giannotti, Antonella; Piazzi, Barbara; Borghi, Tosca

doi:10.1097/00008506-200201000-00010

Cited by 71 publications

(60 citation statements)

References 17 publications

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“…Although nursing guidelines are ambiguous regarding the clustering of interventions, our results demonstrate that the mean percent change in ETCO 2 Suctioning of a patient's endotracheal tube is known to cause an increase in ICP, 12 and suctioning was done 95% of the time during clustering of interventions. Because suctioning also occurred when there was no significant change in ETCO 2 , is there a particular approach to suctioning that does not create as much stress?…”

Section: Discussionmentioning

confidence: 77%

End-Tidal Carbon Dioxide as a Measure of Stress Response to Clustered Nursing Interventions in Neurologic Patients

Genzler

Johnson

Ghildayal

et al. 2013

American Journal of Critical Care

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Background Guidelines recommend rest periods between nursing interventions for patients with a neurologic diagnosis but do not specify a safe number of interventions. Objectives To examine the physiological stress response to clustered nursing interventions in neurologic patients receiving mechanical ventilation. Methods Prospective, comparative, descriptive design to examine effects of clustered interventions (≥6 interventions in a single nursing interaction) versus nonclustered interventions on patients’ stress. Stress response was defined as a 10% change in end-tidal carbon dioxide from before the interaction to (1) 5 and 10 minutes after the start of the interaction, (2) at the end of the interaction, and (3) 15 minutes after the interaction. Results The mean percent change in end-tidal carbon dioxide at 5 minutes differed significantly between patients with clustered interventions and patients with nonclustered interventions (6.7% vs −0.2%; P = .001). Patients with clustered interventions were significantly more likely than patients with low clustering to exhibit a stress response at 5 minutes (24.3% vs 0%; P = .01). Conclusions Neurologic patients receiving mechanical ventilation who experienced 6 or more clustered nursing interventions showed a higher mean change in end-tidal carbon dioxide than did patients who received fewer than 6 clustered interventions. These findings suggest that providing fewer interventions during 1 nursing interaction may minimize induced stress in neurologic patients receiving mechanical ventilation.

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Section: Discussionmentioning

confidence: 77%

End-Tidal Carbon Dioxide as a Measure of Stress Response to Clustered Nursing Interventions in Neurologic Patients

Genzler

Johnson

Ghildayal

et al. 2013

American Journal of Critical Care

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“…(12,13) Theoretically, respiratory physiotherapy measures applied on the chest, increase intrathoracic pressure (ITP) with drop of cerebral venous return and implies increase of ICP. (3,10) Results of this study disclosed that the manual vibrocompression maneuver did not determine an increase of ICP or CPP on any of the assessed days.…”

Section: Discussionmentioning

confidence: 99%

“…(7) Increases of MAP, of jugular venous oxygen tension, velocity of the middle cerebral artery flow are described, which together suggest a protective compensatory response, maintaining the cerebral oxygen delivery during and after ITA. (12,13) Increase of arterial pressure apparently is a compensatory response to the procedure-induced hypoxia. (10) Other authors suggest that the ITA may increase ICP as a response to the cough reflex and to hypercapnia with consequent cerebral vasodilatation.…”

Section: Discussionmentioning

confidence: 99%

Efeitos da fisioterapia respiratória na pressão intracraniana e pressão de perfusão cerebral no traumatismo cranioencefálico grave

Toledo¹,

Garrido²,

Troncoso³

et al. 2008

Rev. bras. ter. intensiva

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“…Heart rate and blood pressure should be monitored closely, as suctioning may stimulate the vagus nerve and produce bradycardia. Lidocaine (administered tracheally, 5-6 mg/kg dose diluted in 6 mL 0.9% saline 5-10 min before suctioning) may be administered in children with head trauma [56][57][58] before the airway is suctioned in order to blunt the increase in intracranial pressure (ICP) that may result from the suctioning [59][60][61][62].…”

Section: Suction Devicesmentioning

confidence: 99%

Assessment and Management of the Pediatric Airway

Wheeler

Spaeth

Mehta

et al. 2008

Resuscitation and Stabilization of the Critically Ill Child

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Anatomic features that differ between children and adults include (1) a proportionally larger head and occiput (relative to body size), causing neck fl exion and leading to potential airway obstruction when lying supine; (2) a relatively larger tongue, decreasing the size of the oral cavity; (3) decreased muscle tone, resulting in passive obstruction of the airway by the tongue; (4) a shorter, narrower, horizontally positioned, softer epiglottis; (5) cephalad and anterior position of the larynx; (6) shorter, smaller, narrower trachea; and (7) funnel-shaped versus cylindrical airway, such that the narrowest portion of the airway is located at the level of the cricoid cartilage (Figure 4.1).The fi rst and perhaps most obvious difference is that the pediatric airway is much smaller in diameter and shorter in length than the adult's. For example, the length of the trachea changes from approximately 4 cm in neonates to approximately 12 cm in adults, and the tracheal diameter varies from approximately 3 mm in the premature infant to approximately 25 mm in the adult [11,13]. According to Hagen-Poiseuille's law, the change in air fl ow resulting from a reduction in airway diameter is directly proportional to the airway radius elevated to the fourth power:

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Intracranial Effects of Endotracheal Suctioning in the Acute Phase of Head Injury

Cited by 71 publications

References 17 publications

End-Tidal Carbon Dioxide as a Measure of Stress Response to Clustered Nursing Interventions in Neurologic Patients

End-Tidal Carbon Dioxide as a Measure of Stress Response to Clustered Nursing Interventions in Neurologic Patients

Efeitos da fisioterapia respiratória na pressão intracraniana e pressão de perfusão cerebral no traumatismo cranioencefálico grave

Assessment and Management of the Pediatric Airway

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