Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil.
Health Technology Assessment Unit, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Pediatr Crit Care Med. 2019 Apr;20(4):365-371. doi: 10.1097/PCC.0000000000001817.
Tracheal suctioning is a routine procedure in mechanically ventilated children, however, in severe head-injured patients it can result in potential deleterious increase in intracranial pressure. We aimed to assess the effect of tracheal lidocaine administration on intracranial pressure during tracheal suctioning.
Prospective randomized controlled crossover study.
PICU of a tertiary hospital.
Eleven patients with severe head trauma (Glasgow Coma Scale score 4-8) INTERVENTIONS:: Lidocaine (1.5 mg/kg) or saline solution was endotracheally instilled before a standardized tracheal suctioning maneuver. Each patient received both treatments in a crossover design. Cerebral hemodynamic and systemic and ventilatory effects were assessed at four time points: in baseline (T0), within 2 minutes (T1), 5 minutes (T2), and 15 minutes after tracheal instillation (T3). The 2-minute time interval around tracheal suctioning was used to assess each treatment efficacy MEASUREMENTS AND MAIN RESULTS:: The time course of intracranial pressure was different throughout the study in both treatment groups, with a significant increase of intracranial pressure from 14.82 ± 3.48 to 23.27 ± 9.06 with lidocaine (p = 0.003) and from 14.73 ± 2.41 to 30.45 ± 13.14 with saline (p = 0.02). The mean variation in intracranial pressure immediately after tracheal suctioning was smaller with lidocaine instillation than saline (8.45 vs 15.72 mm Hg; p = 0.006). Patients treated with lidocaine returned to baseline intracranial pressure value at 5 minutes after tracheal suctioning whereas those receiving saline solution returned to baseline intracranial pressure value at 15 minutes. Although patients treated with lidocaine had no significant hemodynamic changes, patients receiving saline solution experienced a higher mean value of mean arterial pressure (99.36 vs 81.73 mm Hg; p = 0.004) at T1.
This preliminary study showed that tracheal lidocaine instillation can attenuate increase in intracranial pressure induced by tracheal suctioning and favor a faster return to the intracranial pressure baseline levels without significant hemodynamic and ventilatory changes.
气管抽吸是机械通气患儿的常规操作，但在严重颅脑损伤患者中，可能导致颅内压潜在有害增加。我们旨在评估气管内给予利多卡因对气管抽吸期间颅内压的影响。
前瞻性随机对照交叉研究。
一家三级医院的儿科重症监护病房（PICU）。
11 例严重颅脑外伤患者（格拉斯哥昏迷评分 4-8 分）。
利多卡因（1.5mg/kg）或生理盐水在标准化气管抽吸操作前气管内给药。每位患者均以交叉设计接受两种治疗。在四个时间点评估脑血流动力学和全身及通气效果：基础状态（T0）、2 分钟内（T1）、5 分钟（T2）和气管内给药后 15 分钟（T3）。气管抽吸周围的 2 分钟时间间隔用于评估每种治疗的效果。
在两组患者中，整个研究过程中颅内压的时间过程不同，利多卡因组的颅内压从 14.82±3.48mmHg 升高至 23.27±9.06mmHg（p=0.003），生理盐水组从 14.73±2.41mmHg 升高至 30.45±13.14mmHg（p=0.02）。气管抽吸后立即，利多卡因组的颅内压平均变化小于生理盐水组（8.45mmHg 与 15.72mmHg；p=0.006）。接受利多卡因治疗的患者在气管抽吸后 5 分钟内恢复至基础颅内压值，而接受生理盐水治疗的患者在 15 分钟内恢复至基础颅内压值。尽管接受利多卡因治疗的患者无明显血流动力学变化，但接受生理盐水的患者在 T1 时的平均动脉压（99.36mmHg 与 81.73mmHg；p=0.004）有更高的平均值。
这项初步研究表明，气管内给予利多卡因可减轻气管抽吸引起的颅内压升高，并有利于更快地恢复颅内压基线水平，而无明显的血流动力学和通气变化。
