Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

Abstract

Objectives: Examining the effects of tracheal suctioning on cerebral hemodynamics of normotensive ventilated very low birth weight (VLBW) infants with normal cranial ultrasounds; determining the factor(s) influencing changes in mean cerebral blood flow velocity (CBFv) after suctioning. Methods: Seventy-three VLBW infants had continuous monitoring of mean arterial blood pressure (MABP), PaCO2, PaO2 and mean CBFv before, during, and after 202 suctioning sessions during the first week of life. Peak (or nadir) and relative changes of the four variables for 45min after suctioning were calculated. Multiple linear regression was used to determine the factor(s) influencing changes in mean CBFv after suctioning. Result: Birth weight was 928±244g; gestational age was 27.0±2.0 weeks. Mean CBFv increased to 31.0±26.4% after suctioning and remained elevated for 25min. PaCO2 was highly associated with mean CBFv (P<0.001), whereas MABP and PaO2 were not. Conclusion: We observed prolonged increases of mean CBFv following suctioning in ventilated VLBW infants that were previously unrecognized. This is concerning since disturbances of CBF may be associated with subsequent brain injury.