# Pharmacologic and non-pharmacologic strategies to prevent intracranial pressure surges during endotracheal suctioning in acute brain injury: a narrative review

## TL;DR

This review explores ways to prevent dangerous increases in brain pressure during suctioning in patients with brain injuries.

## Contribution

The paper integrates pharmacologic and non-pharmacologic strategies to reduce intracranial pressure surges during endotracheal suctioning.

## Key findings

- An integrated approach combining analgo-sedation and controlled ventilation is recommended.
- Drug selection should be tailored to the patient's condition and available resources.
- Real-time monitoring technologies could improve safety during suctioning.

## Abstract

Endotracheal suctioning remains a critical intervention in the respiratory management of mechanically ventilated patients with brain injury. However, it carries the risk of triggering abrupt intracranial pressure elevations, potentially exacerbating secondary brain injury. This narrative review combines current evidence on pharmacologic and non-pharmacologic strategies to mitigate ICP fluctuations during ETS in neurosurgical patients. The findings support the need for an integrated approach involving analgo-sedation, controlled ventilation, and targeted drug selection to minimize ICP surges and improve outcomes. While each strategy offers distinct benefits, its application must be adapted to the patient’s physiological profile and clinical context, and regional resources. The review also highlights the need for continued research into effective dosing, administration techniques, and the integration of real-time monitoring technologies to enhance procedural safety in this high-risk population.

The online version contains supplementary material available at 10.1186/s12871-026-03615-3.