The Endotracheal Suctioning and Oxygen Saturation in an Intensive Care Patient with Ischemic Stroke and Decreased Consciousness: A Descriptive Case Study
DOI:
https://doi.org/10.33755/jkk.v12i2.999Keywords:
ischemic stroke, nursing care, oxygen saturation, suctioningAbstract
Background: Patients with ischemic stroke and decreased consciousness are at high risk of ineffective airway clearance due to impaired cough reflex and accumulation of airway secretions. This condition may lead to hypoxemia and further neurological deterioration, requiring appropriate airway management in intensive care settings.
Objective: To describe the implementation of endotracheal suctioning as part of nursing care in an intensive care patient with ischemic stroke and decreased consciousness, with particular attention to oxygen saturation and clinical airway status.
Methods: A descriptive single-patient case study was conducted in the general intensive care unit. Data were collected through direct observation, physical examination, bedside monitoring, and medical record review. The nursing care process included assessment, diagnosis, planning, implementation, and evaluation. Endotracheal suctioning was performed according to clinical indications and unit protocol, and oxygen saturation was observed before and after suctioning over a five-day period.
Results: At baseline, the patient presented with decreased consciousness, retained airway secretions, bilateral rhonchi, weak cough reflex, tachypnea, and oxygen saturation of 92%. Across the five-day observation period, suctioning was followed by short-term improvement in oxygen saturation, with post-procedure values reaching 97–98%, accompanied by reduced secretion burden and clearer breath sounds. By the end of observation, respiratory status was more stable and suctioning was required less frequently.
Conclusion: In this case, endotracheal suctioning performed on the basis of clinical indications was associated with improvement in short-term oxygen saturation and airway clearance indicators. These observations should be interpreted within the broader context of comprehensive intensive care and should not be taken as evidence of independent treatment effect. Further studies with stronger designs are needed to evaluate the contribution of suctioning in neurocritical patients
References
1. World Health Organization. Stroke. 2025. Available From: Https://Www.Who.Int/ News-Room/Fact-Sheets/Detail/Stroke [Accessed 5 Feb 2026].
2. Eichler A, Kruse P, Schob C, Lenz M. Synaptic Transmission In Supragranular Layers Of The Human Cortex: Comparative Review Of Structure, Function, And Plasticity. Front Synaptic Neurosci. 2025. Available From: Https://Doi.Org/10.3389/ Fnsyn.2025.1724377
3. Dock H. Understanding Neuro-Anatomy: A Comprehensive Review. 2024;17(5):577-578. Available From : Https://Doi.Org/ 10.37532/1308-4038.17(5).396
4. A Comprehensive Review Of Stroke: Types, Epidemiology, Pathophysiology, And Risk Factors. 2023;15:15-18.
5. Price SA, Wilson LM. Patofisiologi: Konsep Klinis Proses-Proses Penyakit. 6th Ed. Jakarta: EGC; 2006.
6. Amalia L, Qonitah P. Clinical And Epidemiological Overview Of Hyperacute Ischemic Stroke Patients Treated With Intravenous Thrombolysis. Egypt J Intern Med. 2025. Available From: Https://Doi.Org/ 10.1186/S43162-025-00419-8
7. Novita Agustin. Endotrakeal Suctioning. Jakarta: Kementerian Kesehatan RI; 2022. Available From: Https://Keslan.Kemkes. Go.Id/View_Artikel/48/Endotrakeal-Suctioning [Accessed 3 Feb 2026].
8. American Association For Respiratory Care. Artificial Airway Suctioning Clinical Practice Guideline. 2022. Available From: Https://www.Aarc.Org [Accessed 7 Jan 2026].
9. Hidayah VP, Nur. Proses Keperawatan. Fitriani, Editor. Jakarta: Yayasan Pemberdayaan Masyarakat; 2019.
10. Toney-Butler TJ, Thayer JM. Proses Keperawatan. Statpearls Publishing; 2023. Available From: Https://Www.Ncbi.Nlm.Nih .Gov/Books/NBK499937/ [Accessed 5 Jan2026].
11. Care AA for R. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010. Respir Care. 2010;55(6):758–64.
12. Blakeman TC, Scott JB, Yoder MA, Capellari E, Strickland SL. AARC clinical practice guidelines: artificial airway suctioning. Respir Care. 2022;67(2):258–71.
13. da Silva LFM, Pascoal LM, Nunes SFL, deSousa Freire VEC, deAraújo Almeida AG, Gontijo PVC, et al. Ineffective airway clearance in surgical patients: evaluation of nursing interventions and outcomes. Int J Nurs Knowl. 2019;30(4):251–6.
14. Pascoal LM, de Carvalho JPA, de Sousa VEC, Santos FDRP, Neto PML, Nunes SFL, et al. Ineffective airway clearance in adult patients after thoracic and upper abdominal surgery. Applied Nursing Research. 2016;31:24–8.
15. Andrisani G, Andrisani G. Sleep apnea pathophysiology. Sleep and Breathing. 2023;27(6):2111–22.
16. Gilder E, Parke R, Jull A. Closed Versus Open Suction System For Mechanically Ventilated Adults: A Systematic Review. Intensive Crit Care Nurs. 2022;69:103165. Available From: Https://Doi.Org/ 10.1016/J.Iccn.2021.103165
17. Maggiore SM, Lellouche F, Pigeot J, Talmor D. Endotracheal Suctioning Practice And Patient Outcomes In Mechanically Ventilated Patients. J Crit Care. 2021;62:6-12. Available From: Https://Doi.Org/ 10.1016/J.Jcrc.2020.11.013.
18. Powers WJ, Rabinstein AA, Ackerson T, Et Al. Guidelines For The Early Management Of Acute Ischemic Stroke. Stroke. 2023;54(3). Available From: Https://Doi.Org/ 10.1161/STR.0000000000000407.
19. Kementerian Kesehatan Republik Indonesia. Pedoman Nasional Pelayanan Kedokteran Stroke. Jakarta: Kementerian Kesehatan RI; 2022. Available From: Https://Yankes.Kemkes.Go.Id/View_Artikel/165/Stroke [Accessed 3 Feb 2026]
20. Kenhub Gmbh. The Nervous System: Anatomy And Structure. 2023. Available From: Https://Www.Kenhub.Com/En/Library/Anatomy/The-Nervous-System [Accessed 3 Feb 2026].
