Effects of routine position changes and tracheal suctioning on intracranial pressure in traumatic brain injury patients.

Abstract

Patient position change and tracheal suctioning are routine interventions in mechanically ventilated traumatic brain injury (TBI) patients. We sought to better understand the impact of these interventions on intracranial pressure (ICP) and intracerebral hemodynamics. We conducted a prospective study in TBI patients requiring ICP monitoring. The timing of position changes and suctioning episodes was recorded with concurrent blood pressure and ICP measurements. 460 patient position changes and 204 suctioning episodes over 2404 hours were recorded in 18 ventilated patients (mean age 34 (13) years, median Glasgow Coma Score 4 [3-7]). 24 [20-31] positioning and 11 [6-18] suctioning episodes were recorded per patient, with 54% and 39% of position changes associated with ICP ≥ 22mmHg and CPP <60 mmHg respectively, and 22% and 27% of suctioning episodes associated with ICP ≥ 22mmHg and CPP <60 mmHg. Median change in ICP was 11 [6-16] mmHg after position change and 3 [1-9] mmHg after suctioning. Reduction in CPP to <60 mmHg lasted ≥ 10 minutes in 17% of positioning and 11% of suctioning episodes. The baseline ICP and its amplitude were both predictive of a rise in ICP 22 mmHg after positioning and suctioning episodes, whereas cerebral autoregulation was not. Baseline CPP was predictive of a decrease in CPP <60 mmHg after both interventions. Increases in ICP and reductions in CPP are common following patient positioning and tracheal suctioning episodes. Frequently, these changes are substantial and sustained.