Which is Safer to Avoid an Increase in ICP After Endotracheal Suctioning in Severe Head Injury: Intravenous or Endotracheal Lidocaine?

Abstract

Background: In patients with severe head injury, endotracheal suctioning (ES) is a potentially unsafe procedure, because it can increase intracranial pressure (ICP) and decrease cerebral perfusion pressure (CPP). Lidocaine has been shown to directly blunt ICP rises before ES, although it is not known whether the efficacy of lidocaine given endotracheally is comparable with that intravenously. The purpose of this study was evaluated the effects of ES on ICP with or without the use of lidocaine given endotracheally or intravenously in head trauma. Methods: Twenty patients admitted to the intensive care unit having traumatic brain injury with Glasgow Coma Scale ≤ 8 were evaluated. Patients were randomly given 1.5 mg/kg of 2% lidocaine intravenously (Group 1), 1 mg/kg of 2% lidocaine endotracheally (Group 2) or did not receive lidocaine (Group 3) prior to ES. The ICP, mean arterial pressure, heart rate and CPP were monitored continuously and were recorded prior and immediately after ES. Results: There was no significant increase in ICP after ES in group 1 (P = 0.56) and group 2 (P = 0.06) patients. However, the ICP increased after ES in group 3 patients (P = 0.0002). Conclusions: Our findings suggest that the administration of lidocaine endotracheally or intravenously before ES effectively prevents the ICP increase and CPP reduction in severe head trauma. Aiming for patient safety we propose the use of endotracheal lidocaine because intravenous drugs have a heightened risk of causing significant patient harm when used in error and preventable adverse drug events, are a prominent quality and cost issue in healthcare. J Neurol Res. 2013;3(2):51-55 doi: https://doi.org/10.4021/jnr201w