WIP 32 - Efficacy of endotracheal lidocaine in attenuating intracranial pressure spikes in pediatric patients with severe traumatic brain injury : A pilot crossover study

Publication Number: WIP 32.7400

Nikita Tripathi, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Thao L. Nguyen, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Mary Vetter, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Endotracheal suction (ETS) is a routine procedure in mechanically ventilated children. However, in severe traumatic brain injury (TBI), it can cause potentially deleterious increases in intracranial pressure (ICP), which can lead to poor neurological long-term outcomes. There is a significant lack of pediatric trials specifically assessing the efficacy of aerosolized and instilled endotracheal lidocaine in preventing ETS-induced ICP changes

Objective: To evaluate the effectiveness of nebulized lidocaine and instilled endotracheal lidocaine solution compared to normal saline (placebo) in attenuating the increase in ICP following ETS in pediatric patients with severe TBI.

Design/Methods: This is a prospective, crossover pilot study performed at a Level 1 Trauma center in the pediatric intensive care unit. The inclusion criteria included pediatric patients < 18-years old admitted with severe TBI and had ICP monitoring devices in place. The study received IRB approval (UTHealth HSC-MS-21-0254) and written consent obtained from the patients’ legal guardians. Each patient receives all three treatment arms in a randomized, crossover fashion. The treatment arms are: (a) aerosolized 2% lidocaine (1.5 mg/kg), (b) instilled 2% lidocaine (1.5 mg/kg), and (c) 0.9% sodium chloride (NS). All treatments are administered before standardized ETS performed by skilled respiratory therapists and separated by a 6-hour washout period (equivalent to at least 5 plasma half-life of lidocaine).
In addition to demographics, multiple clinical parameters, including ICP, mean arterial pressure and cerebral perfusion pressure, are obtained at various time points before and after medication administration. Descriptive analysis (i.e., t-tests, chi-squared) will analyze categorical variables. Our primary outcome is the mean difference in the maximum ICP measured before and after the interventions. These differences will be statistically analyzed using ANOVA.
Currently, eight patients have been enrolled with a target enrollment of 15 or until February 2025, whichever occurs first.