Cerebral Effects of Suctioning

Cerebral Effects of Suctioning

Kaiser JR, Gauss, CH and Williams DK. Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants. Journal of Perinatology (2008) 28, 34–41. Full Text | PDF Tagetrac

Objectives: Examining the effects of tracheal suctioning on cerebral hemodynamics of normotensive ventilated very low birth weight (VLBW) infants with normal cranial ultrasounds; determining the factor(s) influencing changes in mean cerebral blood flow velocity (CBFv) after suctioning.

Methods: Seventy-three VLBW infants had continuous monitoring of mean arterial blood pressure (MABP), PaCO₂, PaO₂ and mean CBFv before, during, and after 202 suctioning sessions during the first week of life. Peak (or nadir) and relative changes of the four variables for 45 min after suctioning were calculated. Multiple linear regression was used to determine the factor(s) influencing changes in mean CBFv after suctioning.

Result: Birth weight was 928 +/- 244 g; gestational age was 27.0 +/-2.0 weeks. Mean CBFv increased to 31.0 +/-26.4% after suctioning and remained elevated for 25 min. PaCO₂ was highly associated with mean CBFv (P<0.001), whereas MABP and PaO₂ were not.

Conclusion: We observed prolonged increases of mean CBFv following suctioning in ventilated VLBW infants that were previously unrecognized. This is concerning since disturbances of CBF may be associated with subsequent brain injury.

Comments. This interesting study looks at the previously reported increases in cerebral blood flow associated with tracheal suctioning. The strengths of this study are it involves continuous monitoring of CBF, MBP, PCO2 and PO2. Of concern is the finding that it takes approximately 25 minutes after tracheal suctioning for the CBF to return to base line values. The PCO2 and PO2 also mirrored the changes in CBF, however they returned to baseline levels sooner. The limitations of this study are that all babies had normal HUS and were not treated for hypotension, it will be interesting to observe these changes in babies that develop IVH. It would also be of interest to determine if the method of suctioning {in-line suctioning vs. disconnecting from the ventilator circuit (the method used in this study)} would demonstrate similar changes in CBF. The “take home” point from this study is tracheal suctioning should not be routinely scheduled and should be performed only when needed. DB

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