1468 PHYSIOLOGICAL CHANGES INDUCED BY ENDOTRACHEAL INSTILLATION AND SUCTIONING IN CRITICALLY ILL PRETERM INFANTS WITH AND WITHOUT SEDATION

Abstract

Endotracheal instillation and subsequent suctioning produces fluctuations in intracranial pressure (ICP), mean arterial pressure (MAP), heart rate (HR) and tissue oxygenation (PO2) in ventilated, sick preterm infants. In an attempt to evaluate whether these fluctuations could be minimized using parenteral administration of sedation, we studied seven sick preterm infants on intermittent mandatory ventilation with and without sedation on eight occasions. Phenobarbital 10 mg/kg IV was used for sedation. Continuous polygraphic recordings of ICP, MAP, HR and PO2 were obtained. Cerebral perfusion pressure (CPP) was calculated. Using Wilcoxson signed rank test, statistically significant increases in HR, MAP and ICP and a significant decrease in PO2 were observed in these infants using no sedation. However, using sedation, even though significant increases were observed in ICP and a decrease in PO2, they were less than that without sedation. When looked at the changes (Δ) brought about by sedation, resulted in significant blunting of these phasic changes induced by endotracheal instillation and suctioning in MAP, ICP, CPP and PO2. We conclude that sedation produces a significant physiologic advantage to eliminate fluctuations of MAP, ICP and CPP. Thus, this physiologic benefit may at least in part help prevent morbidity commonly observed in these infants.