Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning

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Abstract

Background

To investigate whether the administration of intravenous propofol before endotracheal suctioning (ES) in patients with severe brain disease can reduce the sputum suction response, improve prognosis, and accelerate recovery.

Methods

A total of 208 severe brain disease patients after craniocerebral surgery were enrolled in the study. The subjects were randomly assigned to the experimental group ( n = 104) and the control group ( n = 104). The experimental group was given intravenous propofol (10 ml propofol with 1 ml 2% lidocaine), 0.5–1 mg/kg, before ES, while the control group was subjected to ES only. Changes in vital signs, sputum suction effect, the fluctuation range of intracranial pressure (ICP) before and after ES, choking cough response, short-term complications, length of stay, and hospitalization cost were evaluated. Additionally, the Glasgow Outcome Scale (GOS) prognosis score was obtained at 6 months after the operation.

Results

At the baseline, the characteristics of the two groups were comparable ( P > 0.05). The increase of systolic blood pressure after ES was higher in the control group than in the experimental group ( P < 0.05). The average peak value of ICP in the experimental group during the suctioning (15.57 ± 12.31 mmHg) was lower than in the control group (18.24 ± 8.99 mmHg; P < 0.05). The percentage of patients experiencing cough reaction- during suctioning in the experimental group was lower than in the control group ( P < 0.05), and the fluctuation range of ICP was increased ( P < 0.0001). The effect of ES was achieved in both groups. The incidence of short-term complications in the two groups was comparable ( P > 0.05). At 6 months after the surgery, the GOS scores were significantly higher in the experimental than in the control group (4–5 points, 51.54% vs. 32.64%; 1–3 points, 48.46% vs. 67.36%; P < 0.05). There was no significant difference in the length of stay and hospitalization cost between the two groups.

Conclusions

Propofol sedation before ES could reduce choking cough response and intracranial hypertension response. The use of propofol was safe and improved the long-term prognosis.

The study was registered in the Chinese Clinical Trial Registry on May 16, 2015 (ChiCTR-IOR-15006441).

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Most cited references 28

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Endotracheal suctioning of the adult intubated patient--what is the evidence?

Mette Nielsen, Ingrid Egerod, M. Pedersen … (2009)

Intubated patients may be unable to adequately cough up secretions. Endotracheal suctioning is therefore important in order to reduce the risk of consolidation and atelectasis that may lead to inadequate ventilation. The suction procedure is associated with complications and risks including bleeding, infection, atelectasis, hypoxemia, cardiovascular instability, elevated intracranial pressure, and may also cause lesions in the tracheal mucosa. The aim of this article was to review the available literature regarding endotracheal suctioning of adult intubated intensive care patients and to provide evidence-based recommendations The major recommendations are suctioning only when necessary, using a suction catheter occluding less than half the lumen of the endotracheal tube, using the lowest possible suction pressure, inserting the catheter no further than carina, suctioning no longer than 15s, performing continuous rather than intermittent suctioning, avoiding saline lavage, providing hyperoxygenation before and after the suction procedure, providing hyperinflation combined with hyperoxygenation on a non-routine basis, always using aseptic technique, and using either closed or open suction systems.

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Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice.

Salvatore Maggiore, Francois Lellouche, Claudia Pignataro … (2013)

Little is known about the incidence of and risk factors for adverse effects from endotracheal suctioning. We studied the incidence and risk factors, and evaluated the effect of suctioning practice guidelines.

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Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study

Yongfang Zhou, Xiaodong Jin, Yan-yong Kang … (2014)

Introduction Midazolam and propofol used alone for long-term sedation are associated with adverse effects. Sequential use may reduce the adverse effects, and lead to faster recovery, earlier extubation and lower costs. This study evaluates the effects, safety, and cost of midazolam, propofol, and their sequential use for long-term sedation in critically ill mechanically ventilated patients. Methods A total of 135 patients who required mechanical ventilation for >3 days were randomly assigned to receive midazolam (group M), propofol (group P), or sequential use of both (group M-P). In group M-P, midazolam was switched to propofol until the patients passed the spontaneous breathing trial (SBT) safety screen. The primary endpoints included recovery time, extubation time and mechanical ventilation time. The secondary endpoints were pharmaceutical cost, total cost of ICU stay, and recollection to mechanical ventilation-related events. Results The incidence of agitation following cessation of sedation in group M-P was lower than group M (19.4% versus 48.7%, P = 0.01). The mean percentage of adequate sedation and duration of sedation were similar in the three groups. The recovery time, extubation time and mechanical ventilation time of group M were 58.0 (interquartile range (IQR), 39.0) hours, 45.0 (IQR, 24.5) hours, and 192.0 (IQR, 124.0) hours, respectively; these were significantly longer than the other groups, while they were similar between the other two groups. In the treatment-received analysis, ICU duration was longer in group M than group M-P (P = 0.016). Using an intention-to-treat analysis and a treatment-received analysis, respectively, the pharmaceutical cost of group M-P was lower than group P (P 0.05). The incidence of hypotension in group M-P was lower than group (P = 0.01). Conclusion Sequential use of midazolam and propofol was a safe and effective sedation protocol, with higher clinical effectiveness and better cost-benefit ratio than midazolam or propofol used alone, for long-term sedation of critically ill mechanically ventilated patients. Trial registration Current Controlled Trials ISRCTN01173443. Registered 25 February 2014.

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Author and article information

Contributors

Ling Ye: zerodq_hx@163.com

Journal

Journal ID (nlm-ta): BMC Neurol

Journal ID (iso-abbrev): BMC Neurol

Title: BMC Neurology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2377

Publication date (Electronic): 29 October 2020

Publication date PMC-release: 29 October 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 394

Affiliations

[1 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, West China Hospital, Sichuan University/West China School of Nursing, , Sichuan University, ; Chengdu, Sichuan Province 610041 P. R. China

[2 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Department of Pain Management, West China Hospital, , Sichuan University, ; Chengdu, Sichuan Province 610041 P. R. China

Article

Publisher ID: 1972

DOI: 10.1186/s12883-020-01972-1

PMC ID: 7596952

PubMed ID: 33121474

SO-VID: d944747b-9a45-4994-b1f1-b8d37a1c6a7f

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 10 May 2020

Date accepted : 20 October 2020

Funding

Funded by: Science &Technology Department of Sichuan Province

Award ID: 2015SZ0132

Award ID: 20YYJC2903

Award Recipient : Menghang Wu

Custom metadata

ScienceOpen disciplines: Neurology

Keywords: severe neuropathy,severe brain disease,endotracheal suctioning (es),propofol,sedation,intracranial pressure (icp),nursing

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ScienceOpen disciplines: Neurology

Keywords: severe neuropathy, severe brain disease, endotracheal suctioning (es), propofol, sedation, intracranial pressure (icp), nursing

Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning

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Most cited references 28

Endotracheal suctioning of the adult intubated patient--what is the evidence?

Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice.

Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study

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