| objective: To investigate the change of HR, MAP, SPO2 and rSO2 of the patients with severe traumatic brain injures after tracheotomy suction,who were under the multimodality monitoring and took different depthes of endotracheal suction; to compare the impact of different suction depth on the parameters above and find the optimal suction depth for the patients; to compare the impact of different suction depthes of tracheotomy suction on the improvement of metabolism of oxygen, according to the integrated data based on deep and shallow suction; to evaluate the suction effect of different suction depthes based on the data, which was divided into two types according to the cough reflex of patients. Providing evidence for individualized tracheotomy suction depth with smaller impact on hemodynamics and better effect on metabolism of oxygen and promoting the research of accurate care for patients with severe traumatic brain injures.Methods: 1.This was a prospective single-blinded clinical trial using a crossover design. 38 patients were enrolled in the present study, who were selected from the neurosurgical intensive care unit of a top three hospital in southwest China, since May 2015 until December 2015. 2.An opaque envelope was used to choose the depth and sequence of the monitoring suction（ralated indicators before and after suction was collected in the study, which was called monitoring suction） for the selected patients, randomly. The monitoring suction started at the day after tracheotomy, which last two days. There were 8times monitoring suction（deep and shallow suction were two times,respectively）. All the suction was performed by a single nurse. 3.The suction procedure should be performed when there were signs and symptoms of pulmonary secretion presence; closed endotracheal suction system were used for all the patients; the suction negative pressure was 150 mm Hg（1mm Hg=0.133 k Pa）; the suction depth was carried out as it was determined before. 4.Before the monitoring suction, cough reflex should be tested and recorded by the researcher. The cough reflex was classified into two levels:good and bad. 5.All the patients received continuous monitoring of HR, MAP and Sp O2 with Hewlett-Packard HPM-1205 A monitor, America, and measurement of regional oxygen saturation（rSO2） was also performed, using cerebral oxygen monitor with the brand name of Ming Xi（MNIR-P100）, made in Chongqing, China. 6.The data collection contained sex, age and GCS et al when the patients were enrolled in; after entered the study, the HR, MAP, SPO2 and rSO2 at six time points were measured, namely one minute before monitoring suction and 1, 3, 5 and 10 min after suction, recorded as T1, T2, T3,T4, T5 and T6, respectively. 7.The suction depth was divided into deep suction group and shallow suction group, according the collected data; compare the HR, MAP, SPO2 and rSO2 before and after suction in groups; contrast the HR,MAP, SPO2 and rSO2 at different time point between groups; then divided the collected data into two groups: good cough reflex group and bad cough reflex group, compare the impact of deep and shallow suction on the HR, MAP, SPO2 and rSO2. 8.All the statistical analysis was performed by the use of SPSS 19.0software（SPSS Ver. 19）, data was presented as mean ± standard deviation（SD）, Shapiro-Wilks test was applied to normality test, One-way analysis of variance（ANOVA） were applied to test the Homogeneity of Variance. If the data was normal or nearly normal distribution and equal variance, one-way analysis of variance was performed in group and repeated ANOVA was used between groups, α=0.05 regarded as inspection leve.Results: 1.After a rigorous screening, 38 patients were enrolled in the present study. There were 25 males（66%） and 13 females（34%）; in this study, a total number of monitoring suction was 304. The evaluation of the cough reflex ability contained: good cough reflex 160 times（53%）, it contained deep suction and shallow suction 80 times（50%）, respectively; and bad cough reflex 144 times（47%）, included deep and shallow suction 72 times（50%）,respectively; 2.In deep suction, compared with T1, the mean HR increased at T2, T3 and T4（p<0.01）, and there was no significant difference at T5, T6（p>0.05）. The mean MAP was higher at T2, T3 and T4（p<0.01）, and it showed no significant difference at T5（p>0.05）. However, it was lower at T6 than it at T1 in deep suction（p<0.01）. There were small decrease in Sp O2 at T2（p<0.01）,no significant differences were found at T3 and T1 respectively（p>0.05）, and the level of mean Sp O2 of deep ETS was higher at T4, T5, T6 than the T1 level（p<0.01）. The mean rSO2 of each point had significant differences, compared with T1（p<0.01）, and it was higher at T4 as compared with other time points.3.In shallow suction, compared with T1, the mean HR increased at T2, T3（p<0.01） and decreased at T6（p<0.01）; there was no significant difference at T4,T5（p>0.05）. The mean MAP was higher at T2, T3（p<0.01）, and it showed no significant difference at T4（p>0.05）, However, the mean MAP was lower at T5, T6 than it at T1（p<0.01）. There were small differences in Sp O2 at T2,（p<0.01）, no significant differences were found at T3 and T4,（p>0.05）, compared with T1. The level of mean Sp O2 was higher at T5, T6（p<0.05）. The mean rSO2 of each point has significant differences, compared with T1（p<0.01）,and it was highest at T4. 4. The HR of the patients who was in deep and shallow suction group was 96.78±17.50 and 96.93±17.56（p>0.05） at T1. The Sp O2 was 97.27±2.53 and 97.41±2.209（p > 0.05）, and the rSO2 was 73.90±6.08 and 73.95±5.96（p>0.05）, so they were comparable; changes of the four indicators between deep and shallow ETS at each time point in ten minutes after suctioning had no statistical difference between deep and shallow ETS（p>0.05）. 5. The HR, MAP, SPO2 and rSO2 of patients who had good cough reflex had no significant difference between deep and shallow suction at T1, so they were comparable（p > 0.05）; and it also had no significant difference between deep and shallow suction, within ten minutes after suctioning（p>0.05）. 6. The HR, MAP, SPO2 and rSO2 of patients who had bad cough reflex had no significant difference between deep and shallow suction at T1（p>0.05）; The mean MAP and HR between deep and shallow suction was similar in 10 minutes after suction（p>0.05）; at T5, T6, the mean Sp O2 of deep and shallow ETS had statistical difference（p<0.05）, and it had no statistical difference at T2, T3, T4; and the rSO2 of shallow suction was lower than deep suction, at T4 and T5（p<0.05）.Conclusion: 1.Both in deep and shallow suction, the mean HR and MAP showed an increase for a set amount of time then decreased, that is to say suction did increase the heart rate and blood pressure of patients in a short time,but it can alleviate the high heart rate and high blood pressure caused by ventilation eventually. The mean Sp O2 of the patients in both shallow and deep suction groups was decreased at some time point, then it gradully rose, even higer than the level before suction. We might come to the conclusion that suction helped improve the poor oxygen state caused by ventilation disorder.After deep and shallow suction, the change law of the mean rSO2 was increased firstly and then decreased, and it was the highest at the third minute after suction. So suction helped to improve the rSO2 of patients. The change law of mean HR, MAP, Sp O2 and rSO2 after deep and shallow suction was similar, but the time it needed to return to the level before suction was longer in deep suction. 2.For patients with good cough reflex, the effect of both deep and shallow suction was similar. It was easy to see that the time it needed to convert back or below to the level before suction was longer in deep suction.So shallow suction was recommended for the patients who had good cough reflex. 3.The suction effect of deep suction on Sp O2 and rSO2 was better than shallow suction for the patients whose cough reflex was bad. So deep suction was recommended for the patients who had bad cough reflex. |
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