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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