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Does Tracheal Lidocaine Instillation Reduce Intracranial Pressure Changes After Tracheal Suctioning in Severe Head
Paulo Sérgio Lucas da Silva1, Vania Euzébio de Aguiar1, Marcelo Cunio Machado Fonseca2
1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil.
Insights
Tracheal lidocaine administration can reduce intracranial pressure spikes during suctioning in severe head-injured children. This method also helps intracranial pressure return to baseline faster without adverse hemodynamic effects.
Area of Science:
- Pediatric Critical Care Medicine
- Neurocritical Care
- Anesthesiology
Background:
- Tracheal suctioning is essential for mechanically ventilated children.
- Severe head-injured patients are vulnerable to increased intracranial pressure (ICP) during suctioning.
- Managing ICP is critical in severe head trauma.
Purpose of the Study:
- To evaluate the effect of endotracheal lidocaine on ICP during tracheal suctioning in children with severe head trauma.
- To compare the efficacy of lidocaine versus saline in mitigating ICP elevations.
- To assess hemodynamic and ventilatory effects of lidocaine administration.
Main Methods:
- Prospective randomized controlled crossover study involving 11 severe head-injured children (Glasgow Coma Scale 4-8).
- Patients received either endotracheal lidocaine (1.5 mg/kg) or saline before standardized tracheal suctioning.
- ICP, cerebral hemodynamics, and systemic/ventilatory parameters were measured at baseline and at intervals post-instillation.
Main Results:
- Tracheal lidocaine significantly attenuated the increase in ICP compared to saline (8.45 vs 15.72 mm Hg).
- ICP returned to baseline levels within 5 minutes with lidocaine, versus 15 minutes with saline.
- Lidocaine administration did not cause significant hemodynamic changes, unlike saline which increased mean arterial pressure.
Conclusions:
- Endotracheal lidocaine is effective in reducing ICP surges during tracheal suctioning in pediatric severe head trauma.
- Lidocaine facilitates a quicker return to baseline ICP without compromising hemodynamic stability.
- This intervention offers a potential strategy for safer airway management in this vulnerable patient population.
Objectives:
Tracheal suctioning is a routine procedure in mechanically ventilated children, however, in severe head-injured patients it can result in potential deleterious increase in intracranial pressure. We aimed to assess the effect of tracheal lidocaine administration on intracranial pressure during tracheal suctioning.
Design:
Prospective randomized controlled crossover study.
Setting:
PICU of a tertiary hospital.
Patients:
Eleven patients with severe head trauma (Glasgow Coma Scale score 4-8) INTERVENTIONS:: Lidocaine (1.5 mg/kg) or saline solution was endotracheally instilled before a standardized tracheal suctioning maneuver. Each patient received both treatments in a crossover design. Cerebral hemodynamic and systemic and ventilatory effects were assessed at four time points: in baseline (T0), within 2 minutes (T1), 5 minutes (T2), and 15 minutes after tracheal instillation (T3). The 2-minute time interval around tracheal suctioning was used to assess each treatment efficacy MEASUREMENTS AND MAIN RESULTS:: The time course of intracranial pressure was different throughout the study in both treatment groups, with a significant increase of intracranial pressure from 14.82 ± 3.48 to 23.27 ± 9.06 with lidocaine (p = 0.003) and from 14.73 ± 2.41 to 30.45 ± 13.14 with saline (p = 0.02). The mean variation in intracranial pressure immediately after tracheal suctioning was smaller with lidocaine instillation than saline (8.45 vs 15.72 mm Hg; p = 0.006). Patients treated with lidocaine returned to baseline intracranial pressure value at 5 minutes after tracheal suctioning whereas those receiving saline solution returned to baseline intracranial pressure value at 15 minutes. Although patients treated with lidocaine had no significant hemodynamic changes, patients receiving saline solution experienced a higher mean value of mean arterial pressure (99.36 vs 81.73 mm Hg; p = 0.004) at T1.
Conclusions:
This preliminary study showed that tracheal lidocaine instillation can attenuate increase in intracranial pressure induced by tracheal suctioning and favor a faster return to the intracranial pressure baseline levels without significant hemodynamic and ventilatory changes.
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