Hypocapnia and hyperoxia induction using a hyperventilation protocol in electroconvulsive therapy

Abstract

Introduction: Hyperventilation in electroconvulsive therapy sessions has been associated with seizure threshold, seizure characteristics, and cognitive effects. There is no consensus on the optimal procedure of applying hyperventilation manoeuvres during electroconvulsive therapy.

Material and methods: Prospective evaluation of the effects of systematic use of hyperventilation manoeuvres with facial mask and capnography (protocolized hyperventilation [pHV]), on ventilation parameters and on seizures. The study included a sample of 130 sessions (65 performed according to hyperventilation standard practice and 65 successive sessions, with pHV) of 35 patients over a period of 10 weeks.

Results: The pHV manoeuvres reduced exhaled CO₂ and increased O₂ saturation significantly (P<.001). The average CO₂ reduction achieved was 6.52±4.75mmHg (95% CI -7.7 to -5.3). The CO₂ values after pHV correlated significantly with seizure duration and O₂ values, with other electroencephalographic quality indices. In pHV sessions, compared with sessions performed according to hyperventilation standard practice, the average lengthening of the motor and electroencephalographic seizure was 3.86±14.62 and 4.73±13.95s, respectively. No differences were identified in other ictal quality parameters.

Conclusions: The proposed pHV manoeuvres significantly modify ventilation parameters. The hypocapnia and hyperoxia obtained by applying these manoeuvres lengthen the duration of seizures without worsening the quality of the electroencephalographic trace. The use of pHV is generalisable and might improve electroconvulsive therapy procedure without adding costs.

Keywords: Capnografía; Capnography; Convulsiones; Electroconvulsive therapy; Hiperventilación; Hipocapnia; Hyperventilation; Hypocapnia; Seizures; Terapia electroconvulsiva.