The effect of suction catheter insertion and tracheal stimulation in adults with severe brain injury.

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.