Effective Adaptation of Ventilation Maneuvers in Electroconvulsive Therapy Sessions During the Coronavirus Disease 2019 Pandemic

Arriba-Arnau, Aida de; Llitjos, A. Dalmau; Soria, Virginia; Menchón, José M.; Urretavizcaya, Mikel

doi:10.1097/yct.0000000000000748

Cited by 1 publication

(2 citation statements)

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“…We prospectively collected data from the sessions performed in the ECT Unit of the Bellvitge University Hospital during June 2020 using a ventilation protocol that addresses the need to reduce aerosol-generating bagmask ventilation and isolate possible droplets during the COVID-19 pandemic. 12 We analyzed the effectiveness of this protocol in reaching adequate values of respiratory gases in ECT sessions and adequate seizures. All patients provided written informed consent, and the study was approved by the Bellvitge University Hospital Clinical Research Ethics Committee.…”

Section: Methodsmentioning

confidence: 99%

“…The protocol avoids vigorous BMV manual hyperventilation and mouth manipulation if possible, performing ventilation through the mouth guard if needed and maintaining oxygenation and manual ventilation assistance with a tight sealed BMV under the plastic tent until the patient recovers spontaneous breathing. 12 Patients underwent continuous monitoring throughout all sessions using assessments of electrocardiogram, blood pressure, oxygen saturation (SpO 2 ) by pulse oximetry (Datex Engstrom AS/3™ (Datex-Engström, Helsinki, Finland) anesthesia monitor), and transcutaneous partial pressure of carbon dioxide (TcPCO 2 ) using a noninvasive estimation of partial arterial CO 2 pressure (SenTec ® Digital Monitoring System (SenTec AG, Therwil, Switzerland)).…”

Section: Dovepressmentioning

confidence: 99%

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Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy

Arriba-Arnau¹,

Llitjos²,

Soria³

et al. 2021

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Purpose: Airway management is a key objective in adapted electroconvulsive therapy (ECT) protocols during the COVID-19 pandemic to prevent infection. The objective of this study was to describe the effectiveness of a modified ventilation procedure designed to reduce aerosol-generating bag-mask ventilation (BMV) and isolate possible droplets while maintaining adequate respiratory gas values in ECT sessions. Materials and Methods: This prospective study analyzed the results of the modified protocol applied over a month. Adaptations entailed preoxygenation and extension of the voluntary hyperventilation (VHV) time for two minutes before anesthesia induction, asking patients to hyperventilate with oxygen therapy via nasal cannula and while wearing a face mask. Thereafter, vigorous hyperventilation was avoided, and patients were only assisted with tightly sealed BMV until emergence from anesthesia, isolating the ventilation by using a single-use plastic device. Oxygen saturation (SpO 2 ) and transcutaneous partial pressure of carbon dioxide (TcPCO 2 ) were recorded throughout the session. Results: The study included 74 sessions of bilateral ECT with the modified ventilation protocol in 15 subjects. After VHV, the mean SpO 2 increase was 2.12±2.14%, and the mean TcPCO 2 decrease was 4.05±2.98 mmHg. TcPCO 2 values at the moment of stimulus administration were 2.22±3.07 mmHg below pre-ECT values. The mean EEG seizure was 38.70 ±17.03 s, and postictal suppression was 68.31± 34.58% and 2.13±0.75 on a 0-3 scale. Brief desaturation (SpO 2 <90) of 4-5 seconds duration was observed in 4 sessions. Conclusion: This modified ventilation protocol was effective during COVID-19, and it did not elicit significant side effects. In addition to avoiding vigorous BMV, it induced moderate hypocapnia, which has been tied to seizure optimization and less hypercapnia during the apnea period.

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Section: Methodsmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%