Effect of Positioning during Suctioning on Cerebral Perfusion Pressure among Patients with Traumatic Brain Injury

Naglaa EL Mokadem^1, and Shimaa EL-Sayed¹

¹Critical Care Nursing, Lecturer of Critical Care Nursing, Critical Care Nursing Department, Menoufia University, Egypt

Cite this paper:
Naglaa EL Mokadem and Shimaa EL-Sayed. Effect of Positioning during Suctioning on Cerebral Perfusion Pressure among Patients with Traumatic Brain Injury. American Journal of Nursing Research. 2020; 8(4):435-441. doi: 10.12691/ajnr-8-4-3

Abstract

Background: Traumatic Brain Injury (TBI) is a major cause of morbidity and mortality worldwide. Patients with TBI may need mechanical ventilation because they cannot clear their airway secretions due to decreased consciousness, loss of laryngeal reflexes and an inability to cough. Endotracheal suctioning is important and needed in mechanically ventilated patients for airway clearance, improvement of oxygenation and prevention of atelectasis and infection. However, endotracheal suctioning is an invasive procedure and adversely affects some physiological indicators, such BP, PaO2, O2 saturation, HR, ICP and CPP. Aim: To examine the effect of positioning during endotracheal suctioning on cerebral perfusion pressure among mechanically ventilated patients with traumatic brain injury. Design: A quasi-experimental design (Study-Control) was used. Setting: The current study was conducted at the neurosurgical ICUs in Menoufia University Hospital and the teaching hospital in Shebin AL Khom. Sample: A convenient sample of 100 mechanically ventilated patients with traumatic brain injury were recruited from the neurosurgical ICUs. Tools: A Semi Structured Demographic Sheet; Physiological Measures Recording Sheet including CPP; MAP; CVP and Oxygenation as indicated by ABGs values; and Glasgow Coma Scale (GCS). Results: There was a highly statistically significant increase in CPP (84.30± 6.35, 74.80±8.20) in the study group compared with the control group after endotracheal suctioning and elevating head of bed (HOB) at 30 degrees respectively (P=0.001). Furthermore, there was a statistically significant increase in PaO2 (88. 57±11.50; 73.57±11.24) in the study group compared to the control group after suctioning respectively (P<.05). Also, there was a statistically significant increase in SaO2 (97.43± 2.88, 88.67± 1.72) in the study group compared to the control group after suctioning respectively (P<.05). Recommendations: Initiate the development of clinical practice guidelines for critical care nurses to use head of bed elevation of 30 degrees as routine care during endotracheal suctioning to improve cerebral pressure perfusion and oxygenation for patients with traumatic brain injury.

Keywords:
cerebral pressure perfusion oxygenation endotracheal suctioning traumatic brain injury

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