The Effects of Open and Closed Endotracheal Suctioning on Intracranial Pressure and Cerebral Perfusion Pressure

Abstract

Although endotracheal suctioning is a routine nursing intervention, this procedure can lead to an increase in intracranial pressure (ICP). This study was planned to determine the appropriate suctioning technique (open system suctioning [OS] and closed system suctioning [CS]) to minimize variability of ICP and cerebral perfusion pressure (CPP) in neurologically impaired patients. The study, which was designed as a crossover, single-blind clinical trial, consisted of 32 neurosurgical patients who underwent ICP monitoring, intra-arterial blood pressure monitoring, and endotracheal intubation in the intensive care unit. According to the need for suctioning, each patient in the experimental and control groups underwent suctioning with both closed and open systems. Recordings were composed of the patients' ICP, mean arterial blood pressure, CPP, heart rate (HR), and arterial blood gases during suctioning. It was observed that both suctioning techniques significantly increased ICP, mean arterial blood pressure, CPP, and HR; ICP was found to be significantly higher in OS compared with CS, whereas there were no significant differences in CPP and HR between the two techniques. The patients suctioned using OS had significantly lower mean PaO(2) than those suctioned using CS; however, the comparison of the two techniques revealed no significant differences in PaCO(2). The data obtained indicate that CS, compared with OS, can be used safely on this patient group.

Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients

“…Potentially, drainage of oxygenated air along with bronchial secretions during open ES significantly decreases PaO 2 and thus, leads to hypoxemia; this scenario is less likely to occur during closed ES (Lorente et al , ), and hypoxemia can be prevented using closed ES (Lasocki et al , ). Studies evaluating the effects of ES on PaO 2 report a more decreased PaO 2 during open ES than closed ES and a markedly increased PaO 2 in patients receiving closed ES, which is consistent with this study (Bourgault et al , ; Uğraş and Aksoy, ).…”

“…In the closed ES patient group, there was also a significant mean HR increase ( p < 0·05), but the change immediately post‐procedure was less than observed in the open ES patient group (Table ). Uğraş and Aksoy () similarly reported that HR increased during both open and closed ES, but the increase during closed ES was not significant.…”

“…This study evaluated the effect of open and closed ES on HR, arterial blood pressure and arterial blood gases in two patient populations who received either open ES ( n = 60) or closed ES ( n = 60). ES is known to increase HR, which is attributed to mechanical stimulation from the catheter, as well as fear, pain and stress experienced by patients during the procedure (Bourgault et al , ; Özden, ; Uğraş and Aksoy, ). In the patients who underwent open ES, initial mean HR significantly increased immediately after the procedure terminated, and by 15 min post‐ES, mean HR decreased to its initial value ( p < 0·05, Table ).…”

“…In addition, the patient may also experience increased arterial blood pressure and heart rate (HR) during this transition, which can impair the cardiac rhythm (Johnson et al , ; Masry et al, ). By contrast, the patient remains connected to mechanical ventilation during closed ES, and reportedly, complications such as decreased lung volume, hypoxemia, hypertension and cardiac arrhythmia are prevented (Johnson et al , ; Lee et al , ; Lasocki et al, ; Uğraş and Aksoy, ). Several studies report that, the closed suction system reduces ventilator‐related pneumonia incidence, which shortens the hospital stay duration, reduces the cost of care and improves the quality of patient care (Johnson et al, ; Blacwood, ; Combes et al , ).…”

“…Jongerden et al () assert that both systems can be considered equally safe. Several studies compare physiological disturbances in patients first undergoing the open ES followed by closed ES (Johnson et al , ; Cereda et al, ; Lee et al, ; Bourgault et al, ; Lasocki et al, ; Uğraş and Aksoy, ). Most study results favoured closed ES, but the differences between the systems were rather small and clinically irrelevant (Jongerden et al, ).…”