Endotracheal suctioning is the primary method used to maintain patency of the airway and remove accumulated secretions and debris from the intubated neonate. Despite the routine nature of the procedure there is little data on the effects of the various components of the procedure on the neonate. The procedure has been associated with complications including hypoxia, bradycardia, increased intracranial pressure, atelectasis and tracheal lesions. In this study 30 intubated newborns will receive 4 endotracheal suctioning procedures within a 6 hour time period to determine the effect of head rotation and number of suction catheter entries during endotracheal suctioning on oxygenation, secretion recovery and intracranial pressure. The independent variables will include head rotation (turning the head to the right and left during suctioning versus no head rotation) combined with 2 or 3 passes of the suction catheter during on suctioning procedure. Oxygenation will be measured transcutaneously by an oxygen saturation monitor connected to a recorder placed on the infant's hand or foot. Intracrancial pressure will be monitored noninvasively by placing a probe over the anterior fontanell of the infant prior to, during and following suctioning. Secretion recovery will be determined by weighing suction catheters and tubing before and immediately following the suctioning procedure. The data will be analyzed by analysis of variance for repeated measures (RM-ANOVA) to determine the effect of the endotracheal suctioning protocol on oxygen saturation, secretion recovery and intracranial pressure. Should the use of head rotation be associated with hypoxia and increased intracranial pressure and yet not facilitate the recovery of secretions then this maneuver could be eliminated from the endotracheal suctioning procedure. Likewise if an extra pass of the suction catheter during endotracheal suctioning does not remove additional secretions yet is associated with hypoxia and changes in intracranial pressure then two passes of the suction catheter during endotracheal suctioning would be adequate.
