Which is Safer to Avoid an Increase in ICP After Endotracheal Suctioning in Severe Head Injury: Intravenous or Endotracheal Lidocaine?
Bibliographic record
Abstract
Background: In patients with severe head injury, endotracheal suctioning (ES) is a potentially unsafe procedure, because it can increase intracranial pressure (ICP) and decrease cerebral perfusion pressure (CPP). Lidocaine has been shown to directly blunt ICP rises before ES, although it is not known whether the efficacy of lidocaine given endotracheally is comparable with that intravenously. The purpose of this study was evaluated the effects of ES on ICP with or without the use of lidocaine given endotracheally or intravenously in head trauma. Methods: Twenty patients admitted to the intensive care unit having traumatic brain injury with Glasgow Coma Scale ≤ 8 were evaluated. Patients were randomly given 1.5 mg/kg of 2% lidocaine intravenously (Group 1), 1 mg/kg of 2% lidocaine endotracheally (Group 2) or did not receive lidocaine (Group 3) prior to ES. The ICP, mean arterial pressure, heart rate and CPP were monitored continuously and were recorded prior and immediately after ES. Results: There was no significant increase in ICP after ES in group 1 (P = 0.56) and group 2 (P = 0.06) patients. However, the ICP increased after ES in group 3 patients (P = 0.0002). Conclusions: Our findings suggest that the administration of lidocaine endotracheally or intravenously before ES effectively prevents the ICP increase and CPP reduction in severe head trauma. Aiming for patient safety we propose the use of endotracheal lidocaine because intravenous drugs have a heightened risk of causing significant patient harm when used in error and preventable adverse drug events, are a prominent quality and cost issue in healthcare. doi: http://dx.doi.org/10.4021/jnr201w
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".