CHANGES IN ICP FOLLOWING RESPONSE CHECKING AND SUCTIONING IN

NEUROSURGICAL INTENSIVE CARE UNIT (NSICU)

Anjusha T ,Deepak AgrawalDepartment of Neurosurgery

JPN Apex Trauma Centre, AIIMS, New Delhi

BACKGROUND OF THE STUDYPresence of intracranial hypertension after

traumatic brain injury (TBI) affects patient’s

outcome

Patients with head injury require elective ventilation

and sedation to decrease ICP and any increase in

ICP (even for brief period) may be detrimental

BACKGROUND Cont….ICP cannot be reliably estimated from any specific

clinical features or CT findings and must actually be

measured. So ICP data from electronic monitoring

equipment are usually calculated and recorded

hourly in the clinical chart by trained nurses

Normal ICP ranges from 1-15mm Hg

ICP MONITORING METHODSThere are mainly three ways for measuring ICP

By using intraventricular catheter

Subarachnoid screw or bolt

Epidural sensor

CODMAN Parenchymal Monitoring system

(Electronic)

ICP MONITORING DEVICES

Codman monitor

Nursing care activities and environmental stimuli

have the potential to challenge the cerebrovascular

system and capacity to increase the ICP

RATIONALE FOR STUDY

RATIONALE FOR STUDYpositioning, coughing, straining, valsalva maneuver,

response checking and invasive procedures like

venipuncture and suctioning may result in sustained

increase in ICP.

Among these endotracheal suctioning plays a major

role in a significant increase in ICP

AIMS & OBJECTIVESTo monitor the variations in ICP during GCS

response checking

To monitor the variations in ICP during suctioning

To assess the time duration to return to the baseline

ICP, in both the cases

To compare the variation in ICP during response

checking and suctioning

METHODOLOGY Study Design : Prospective observational

Study

Sampling Technique : Convenience Sampling

Setting : NSICU,JPNA Trauma Centre

Inclusion Criteria : Ventilated severe head injury

patients

with ICP monitoring in NSICU

Monitoring : Using intraparenchymal Codman

catheter

PROCEDURE- At first the baseline ICP was recorded.

- It was followed by response checking using supra orbital pain stimuli & peak ICP as well as time to return to the baseline was noted.

- In the same way the ICP was assessed while doing oro-tracheal suctioning.

- The variation in ICP in both cases as well as the duration of change was noted

OBSERVATIONSThe total no. of patients taken - 12

The total no. of readings – 54

Mean GCS – 6.87

Mean variation in ICP during response checking–6.19mmHg

(67% increase from baseline)

Mean variation in ICP during suctioning-19.61mmHg

(168% increase from baseline)

OBSERVATIONS

Mean duration of raised ICP with response checking

9.76 seconds

Mean duration of raised ICP with suctioning

26.56 seconds

OBSERVATIONS

Patient 1Graph showing change in ICP with time during

response checking

Patient 1Graph showing change in ICP with time during

suctioning

STATISTICAL ANALYSIS

A paired T test was done

Change in ICP during response checking was highly significant [p<0.001]

Change in ICP during suctioning was also very highly significant [p<0.001]

CONCLUSIONSThere is a wide fluctuation of ICP following response

checking and suctioning.

Significant rise in ICP occurs with GCS response

checking as well as suctioning

CONCLUSIONSThis rise in ICP and time to return to baseline are

significantly higher during suctioning compared to

response checking.

Our study suggests that extra-sedation may be

warranted prior to suctioning to prevent the rise in

ICP.

THANK YOU