Evaluation of the effect of endotracheal aspiration at different head heights on oxygenation of the brain by non‐invasive method in intensive care patients

• Published in: Journal of clinical nursing 2022-06, Vol.31 (11-12), p.1709-1720
• Main Authors: Köstekli, Sibel, Çelik, Sevim, Keskin, Emrah
• Format: Article
• Language: English
• Subjects: Airway management; Brain; cerebral oxygenation; Critical Care; endotracheal aspiration; head height; Health risks; Humans; Intensive care; Monitoring, Physiologic; Neurosurgery; nursing interventions; Oxygen saturation; Prospective Studies; Pulmonary aspiration
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.16314

Objectives To determine the effect of endotracheal aspiration at different head heights on oxygenation brain by non‐invasive method in neurosurgery intensive care patients. Background Head elevation of mechanical ventilator‐dependent neurosurgery patients and the possible risks of endotracheal aspiration are closely related to the clinical conditions of the patients. Design A prospective quasi‐experimental study with repetitive measurements in a single group. Methods In the study, neurosurgery intensive care patients were adjusted to a head height of 15, 30 and 45° (n = 46, power analysis %90). Cerebral oxygenation levels were determined with a non‐invasive device at each head height before and in the 1st, 5th and 30th min of endotracheal aspiration. Data were collected with Patient Information Form and cerebral oxygenation device based on NIRS technology. This study performed according to the TREND reporting guidelines for non‐randomized/quasi experimental study. Results The highest cerebral oxygenation value was obtained at 30 min. The decrease in the cerebral oxygenation levels of the patients was highest in the 1st min after endotracheal aspiration, at a head height of 15 degrees for the right cerebral region and at a head height of 30 degrees for the left cerebral region. The increase in oxygenation of the right and left cerebral regions occurred highest at a head height of 45 degrees. Conclusions The ideal head height should be 45 degrees during and after endotracheal aspiration in regard to maintaining cerebral oxygenation in neurosurgery intensive care patients. It is extremely important to monitor the cerebral oxygenation status of patients, with non‐invasive measurement tools during and after endotracheal aspiration, to prevent secondary complications. Relevance to clinical practice This study reveals the importance of raising the head 45 degrees in the best preservation of cerebral oxygenation values in neurosurgery intensive care patients. Intensive care nurses should pay attention to maintaining this head height.