Aida de Arriba-Arnau1, Antonia Dalmau2, Virginia Soria3, Neus Salvat-Pujol1, Carmina Ribes4, Ana Sánchez-Allueva4, José Manuel Menchón3, Mikel Urretavizcaya5. 1. Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL) Neurosciences Group-Psychiatry and Mental Health, L'Hospitalet de Llobregat, Barcelona, Spain. 2. Department of Anesthesiology, Reanimation and Pain Clinic, Bellvitge University Hospital, L´Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain. 3. Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL) Neurosciences Group-Psychiatry and Mental Health, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain; CIBERSAM, Spain. 4. Department of Anesthesiology, Reanimation and Pain Clinic, Bellvitge University Hospital, L´Hospitalet de Llobregat, Barcelona, Spain. 5. Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL) Neurosciences Group-Psychiatry and Mental Health, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain; CIBERSAM, Spain. Electronic address: murretavizcaya@bellvitgehospital.cat.
Abstract
BACKGROUND: Hyperventilation is recommended in electroconvulsive therapy (ECT) to enhance seizures and to increase patients' safety. However, more evidence is needed regarding its effects and the optimum method of application. METHODS: This prospective study involving 21 subjects compared two procedures, protocolized hyperventilation (PHV) and hyperventilation as usual (HVau), applied to the same patient in two consecutive sessions. Transcutaneous partial pressure of carbon dioxide (TcPCO2) was measured throughout all sessions. Ventilation parameters, hemodynamic measures, seizure characteristics, and side effects were also explored. RESULTS: PHV resulted in lower TcPCO2 after hyperventilation (p=.008) and over the whole session (p=.035). The lowest TcPCO2 was achieved after voluntary hyperventilation. Changes in TcPCO2 from baseline showed differences between HVau and PHV at each session time-point (all p<.05). Between- and within-subjects factors were statistically significant in a general linear model. Seizure duration was greater in PHV sessions (p=.028), without differences in other seizure quality parameters or adverse effects. Correlations were found between hypocapnia induction and seizure quality indexes. LIMITATIONS: Secondary outcomes could be underpowered. CONCLUSIONS: PHV produces hypocapnia before the stimulus, modifies patients' TcPCO2 values throughout the ECT session and lengthens seizure duration. Voluntary hyperventilation is the most important part of the PHV procedure with respect to achieving hypocapnia. A specific ventilation approach, CO2 quantification and monitoring may be advisable in ECT. PHV is easy to apply in daily clinical practice and does not imply added costs. Ventilation management has promising effects in terms of optimizing ECT technique.
BACKGROUND: Hyperventilation is recommended in electroconvulsive therapy (ECT) to enhance seizures and to increase patients' safety. However, more evidence is needed regarding its effects and the optimum method of application. METHODS: This prospective study involving 21 subjects compared two procedures, protocolized hyperventilation (PHV) and hyperventilation as usual (HVau), applied to the same patient in two consecutive sessions. Transcutaneous partial pressure of carbon dioxide (TcPCO2) was measured throughout all sessions. Ventilation parameters, hemodynamic measures, seizure characteristics, and side effects were also explored. RESULTS: PHV resulted in lower TcPCO2 after hyperventilation (p=.008) and over the whole session (p=.035). The lowest TcPCO2 was achieved after voluntary hyperventilation. Changes in TcPCO2 from baseline showed differences between HVau and PHV at each session time-point (all p<.05). Between- and within-subjects factors were statistically significant in a general linear model. Seizure duration was greater in PHV sessions (p=.028), without differences in other seizure quality parameters or adverse effects. Correlations were found between hypocapnia induction and seizure quality indexes. LIMITATIONS: Secondary outcomes could be underpowered. CONCLUSIONS: PHV produces hypocapnia before the stimulus, modifies patients' TcPCO2 values throughout the ECT session and lengthens seizure duration. Voluntary hyperventilation is the most important part of the PHV procedure with respect to achieving hypocapnia. A specific ventilation approach, CO2 quantification and monitoring may be advisable in ECT. PHV is easy to apply in daily clinical practice and does not imply added costs. Ventilation management has promising effects in terms of optimizing ECT technique.
Authors: James Luccarelli; Claudia Fernandez-Robles; Carlos Fernandez-Robles; Ryan J Horvath; Sheri Berg; Thomas H McCoy; Stephen J Seiner; Michael E Henry Journal: Psychother Psychosom Date: 2020-06-18 Impact factor: 17.659
Authors: Aida de Arriba-Arnau; Antònia Dalmau Llitjos; Virginia Soria; José Manuel Menchón; Mikel Urretavizcaya Journal: J ECT Date: 2021-06-01 Impact factor: 3.635
Authors: Aida de Arriba-Arnau; Antònia Dalmau Llitjos; Virginia Soria; Javier Labad; José Manuel Menchón; Mikel Urretavizcaya Journal: Neuropsychiatr Dis Treat Date: 2021-05-20 Impact factor: 2.570