Protocolized hyperventilation enhances electroconvulsive therapy
| Autor: | Aida de Arriba-Arnau, Ana Sánchez-Allueva, Carmina Ribes, Mikel Urretavizcaya, Antonia Dalmau, Neus Salvat-Pujol, Virginia Soria, José M. Menchón |
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| Rok vydání: | 2017 |
| Předmět: |
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medicine.medical_treatment Treatment outcome Hemodynamics 03 medical and health sciences 0302 clinical medicine Electroconvulsive therapy Hypocapnia Seizures Hyperventilation medicine Humans Prospective Studies Electroconvulsive Therapy Adverse effect Prospective cohort study Aged Mental Disorders Carbon Dioxide Middle Aged medicine.disease Respiration Artificial 030227 psychiatry Clinical Practice Psychiatry and Mental health Clinical Psychology Treatment Outcome Anesthesia Female medicine.symptom Psychology 030217 neurology & neurosurgery |
| Zdroj: | Journal of Affective Disorders. 217:225-232 |
| ISSN: | 0165-0327 |
| DOI: | 10.1016/j.jad.2017.04.007 |
| Popis: | 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 s 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. |
| Databáze: | OpenAIRE |
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