Background: Endotracheal (ET) suctioning causes cardiovascular side effects and may impair cerebral hemodynamics. Subjectively, these effects are worse if patients are disconnected from the ventilator (open system suctioning, OSS) than if they remain connected to the ventilator during suctioning (closed system suctioning, CSS). It is uncertain whether the response to ET suctioning is similar in conventionally (CV) and high frequency (HF) ventilated patients.
Objectives: To investigate if the mode of suctioning or of mechanical ventilation influences cerebral blood flow velocities (CBFVs) in extremely low birth weight (ELBW) infants.
Methods: Transcranial Doppler sonography in the middle cerebral artery during OSS and CSS in CV and HF ventilated ELBW infants.
Results: Forty-one measurements were performed in 19 infants within the first two weeks of life. Mean CBFVs decreased during suctioning from baseline 18.8 to 14.3 cm/s (−24%), increased thereafter to 24.7 cm/s (73%) and then returned to baseline (20.8 cm/s). Changes in CBFV were less pronounced in infants with higher baseline CBFVs. Heart rate decreased during ET suctioning and thereafter returned to baseline values. The alterations in CBFV and heart rate were both independent of the mode of ventilation or suctioning.
Conclusions: The mode of suctioning or ventilation does not influence CBFVs in ELBW infants.
1 Bodai BI, S Briggs, M Goldstein, G McLoughlin, A Haas: Evaluation of the ability of the Neo2Safe valve to minimize desaturation in neonates during suctioning. Respir Care34 (1989) 355Search in Google Scholar
2 Cabal L, S Devaskar, B Siassi, et al.: New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning. Crit Care Med7 (1979) 552Search in Google Scholar
3 Carlon GC, SJ Fox, NJ Ackerman: Evaluation of a closed-tracheal suction system. Crit Care Med15 (1987) 522Search in Google Scholar
4 Choong K, P Chatrkaw, H Frndova, PN Cox: Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning. Pediatr Crit Care Med4 (2003) 69Search in Google Scholar
5 Courtney SE, DJ Durand, JM Asselin, ML Hudak, JL Aschner, CT Shoemaker: High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants. N Engl J Med347 (2002) 643Search in Google Scholar
6 Craig KC, MS Benson, DJ Pierson: Prevention of arterial oxygen desaturation during closed-airway endotracheal suctioning: Effect of ventilator mode. Respir Care29 (1984) 1013Search in Google Scholar
7 Daicoff BB, MR Langham Jr, TW Mullet, HN Yarandi: Physiologic response to two endotracheal suctioning techniques in newborn lambs with and without acute pulmonary hypertension. Am J Crit Care4 (1995) 453Search in Google Scholar
8 Fanconi S, G Duc: Intratracheal suctioning in sick preterm infants: prevention of intracranial hypertension and cerebral hypoperfusion by muscle paralysis. Pediatrics79 (1987) 538Search in Google Scholar
9 Giller CA, G Bowman, H Dyer, L Mootz, W Krippner: Cerebral arterial diameters during changes in blood pressure and carbon dioxide during craniotomy. Neurosurgery32 (1993) 737; discussion 741Search in Google Scholar
10 Graff M, J France, IM Hiatt, T Hegyi: Prevention of hypoxia and hyperoxia during endotracheal suctioning. Crit Care Med15 (1987) 1133Search in Google Scholar
11 Gunderson LP, AJ McPhee, EF Donovan: Partially ventilated endotracheal suction. Use in newborns with respiratory distress syndrome. Am J Dis Child140 (1986) 462Search in Google Scholar
12 Ipsiroglu OS, F Eichler, S Stoeckler-Ipsiroglu: Cerebral Doppler sonography of the neonate. A resume after 20 years and future aspects. Clin Perinatol26 (1999) 905Search in Google Scholar
13 Johnson KL, PA Kearney, SB Johnson, JB Niblett, NL MacMillan, RE McClain: Closed versus open endotracheal suctioning: costs and physiologic consequences. Crit Care Med22 (1994) 658Search in Google Scholar
14 Jorch G, N Jorch: Failure of autoregulation of cerebral blood flow in neonates studied by pulsed Doppler ultrasound of the internal carotid artery. Eur J Pediatr146 (1987) 468Search in Google Scholar
15 Kalyn A, S Blatz, F Sandra, B Paes, C Bautista: Closed suctioning of intubated neonates maintains better physiologic stability: a randomized trial. J Perinatol23 (2003) 218Search in Google Scholar
16 Kohlhauser C, G Bernert, M Hermon, C Popow, R Seidl, A Pollak: Effects of endotracheal suctioning in high-frequency oscillatory and conventionally ventilated low birth weight neonates on cerebral hemodynamics observed by near infrared spectroscopy (NIRS). Pediatr Pulmonol29 (2000) 270Search in Google Scholar
17 Liem KD, JCW Hopman, B Oesenburg, WB Geven, AFJ de Haan, LAA Kollee: Cerebral oxygenation and hemodynamics during open and closed endotracheal suctioning in ventilated preterm infants. Prenat Neonat Med3 (1998) 401Search in Google Scholar
18 Menke J, E Michel, H Rabe, et al.: Simultaneous influence of blood pressure, PCO2, and PO2 on cerebral blood flow velocity in preterm infants of less than 33 weeks' gestation. Pediatr Res34 (1993) 173Search in Google Scholar
19 Mosca FA, M Colnaghi, M Lattanzio, M Bray, S Pugliese, M Fumagalli: Closed versus open endotracheal suctioning in preterm infants: effects on cerebral oxygenation and blood volume. Biol Neonate72 (1997) 9Search in Google Scholar
20 Newell DW, R Aaslid, A Lam, TS Mayberg, HR Winn: Comparison of flow and velocity during dynamic autoregulation testing in humans. Stroke25 (1994) 793Search in Google Scholar
21 Pellicer A, F Gaya, R Madero, J Quero, F Cabanas: Noninvasive continuous monitoring of the effects of head position on brain hemodynamics in ventilated infants. Pediatrics109 (2002) 434Search in Google Scholar
22 Perlman JM, JJ Volpe: Suctioning in the preterm infant: effects on cerebral blood flow velocity, intracranial pressure, and arterial blood pressure. Pediatrics72 (1983) 329Search in Google Scholar
23 Pryds O, G Greisen, LL Skov, B Friis-Hansen: Carbon dioxide-related changes in cerebral blood volume and cerebral blood flow in mechanically ventilated preterm neonates: comparison of near infrared spectrophotometry and 133 Xenon clearance. Pediatr Res27 (1990) 445Search in Google Scholar
24 Rennie JM: Cerebral blood flow velocity variability after cardiovascular support in premature babies. Arch Dis Child64 (1989) 89710.1136/adc.64.7_Spec_No.897Search in Google Scholar
25 Schlosser RL, B Voigt, V von Loewenich: [Cerebral perfusion in newborn infants treated with high-frequency oscillation ventilation]. Klin Padiatr212 (2000) 308Search in Google Scholar
26 Seri I, G Rudas, Z Bors, B Kanyicska, T Tulassay: Effects of low-dose dopamine infusion on cardiovascular and renal functions, cerebral blood flow, and plasma catecholamine levels in sick preterm neonates. Pediatr Res34 (1993) 742Search in Google Scholar
27 Shah AR, CD Kurth, SG Gwiazdowski, B Chance, M Delivoria-Papadopoulos: Fluctuations in cerebral oxygenation and blood volume during endotracheal suctioning in premature infants. J Pediatr120 (1992) 769Search in Google Scholar
28 Simbruner G, H Coradello, M Fodor, L Havelec, G Lubec, A Pollak: Effect of tracheal suction on oxygenation, circulation, and lung mechanics in newborn infants. Arch Dis Child56 (1981) 326Search in Google Scholar
29 Skov L, J Ryding, O Pryds, G Greisen: Changes in cerebral oxygenation and cerebral blood volume during endotracheal suctioning in ventilated neonates. Acta Paediatr81 (1992) 389Search in Google Scholar
30 Traverse JH, H Korvenranta, EM Adams, DA Goldthwait, WA Carlo: Impairment of hemodynamics with increasing mean airway pressure during high-frequency oscillatory ventilation. Pediatr Res23 (1988) 628Search in Google Scholar
31 Valdueza JM, JO Balzer, A Villringer, TJ Vogl, R Kutter, KM Einhaupl: Changes in blood flow velocity and diameter of the middle cerebral artery during hyperventilation: assessment with MR and transcranial Doppler sonography. AJNR Am J Neuroradiol18 (1997) 1929Search in Google Scholar
32 Zmora E, TA Merritt: Use of side-hole endotracheal tube adapter for tracheal aspiration. A controlled study. Am J Dis Child134 (1980) 250Search in Google Scholar
©2005 by Walter de Gruyter Berlin New York