It is suggested that a bolus of sedation should be given prior to nursing interventions (especially ETS) to prevent rises in systemic blood pressure and ICP. However, it is also important to prevent sudden drops in blood pressure and cerebral perfusion by giving too much sedation; therefore, a balance needs to be achieved. The use of neuromuscular blockade drugs,such as rocuronium or atracurium, may be given prior to ETS as they reduce the incidence of coughing which
will cause a rise in ICP. Suctioning should be performed if clinically indicated, and interventions of preoxygenation and sedation are recommended. ETS should be limited to 15 s per suction pass, using a maximum of two suction passes
and allowing 10 min for ICP to return to baseline before further interventions.