de Arriba-Arnau Aida, Dalmau Antonia, Soria Virginia, Salvat-Pujol Neus, Ribes Carmina, Sánchez-Allueva Ana, Menchón José Manuel, Urretavizcaya Mikel
Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL) Neurosciences Group-Psychiatry and Mental Health, L'Hospitalet de Llobregat, Barcelona, Spain.
Department of Anesthesiology, Reanimation and Pain Clinic, Bellvitge University Hospital, L´Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
J Affect Disord. 2017 Aug 1;217:225-232. doi: 10.1016/j.jad.2017.04.007. Epub 2017 Apr 13.
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.
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 (TcPCO) was measured throughout all sessions. Ventilation parameters, hemodynamic measures, seizure characteristics, and side effects were also explored.
PHV resulted in lower TcPCO after hyperventilation (p=.008) and over the whole session (p=.035). The lowest TcPCO was achieved after voluntary hyperventilation. Changes in TcPCO 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.
Secondary outcomes could be underpowered.
PHV produces hypocapnia before the stimulus, modifies patients' TcPCO 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, CO 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.
在电休克治疗（ECT）中推荐进行过度通气，以增强癫痫发作并提高患者安全性。然而，关于其效果和最佳应用方法仍需要更多证据。
这项前瞻性研究纳入了21名受试者，比较了两种程序，即规范化过度通气（PHV）和常规过度通气（HVau），在连续两个疗程中应用于同一患者。在所有疗程中均测量经皮二氧化碳分压（TcPCO）。还探讨了通气参数、血流动力学指标、癫痫发作特征和副作用。
PHV在过度通气后（p = 0.008）以及整个疗程中（p = 0.035）导致更低的TcPCO。自主过度通气后达到最低的TcPCO。从基线开始的TcPCO变化在每个疗程时间点显示出HVau和PHV之间的差异（所有p < 0.05）。在一般线性模型中，受试者间和受试者内因素具有统计学意义。PHV疗程中的癫痫发作持续时间更长（p = 0.028），其他癫痫发作质量参数或不良反应无差异。发现低碳酸血症诱导与癫痫发作质量指标之间存在相关性。
次要结果可能效力不足。
PHV在刺激前产生低碳酸血症，在整个ECT疗程中改变患者的TcPCO值并延长癫痫发作持续时间。就实现低碳酸血症而言，自主过度通气是PHV程序的最重要部分。在ECT中，采用特定的通气方法、二氧化碳定量和监测可能是可取的。PHV易于在日常临床实践中应用且不意味着额外成本。通气管理在优化ECT技术方面具有有前景的效果。
