The Value of Integrated Pulmonary Index Monitoring After Electroconvulsive Therapy

Year 2022, Volume: 5 Issue: 3, 295 - 305, 31.12.2022

Demet Laflı Tunay

https://doi.org/10.36516/jocass.1220726

Cited By: 1

Abstract

Abstract
Aim: The Integrated Pulmonary Index (IPI) is an algorithm integrated 4 major parameters end-tidal carbon dioxide (EtCO2), respiratory rate (RR), oxygen saturation (SpO2), and pulse rate (PR) measured by commercially available monitors in order to provide a simple indication of the patient’s overall ventilatory status. IPI provides to determine the need for additional clinical assessment or intervention by evaluating respiratory status of patient. The aim of the study was to study the value of IPI monitoring for assessment of respiratory status and recovery from anesthesia after electroconvulsive therapy (ECT).
Methods: Total 64 patients, ranging in age from 18 to 65 years and undergoing ECT for various psychiatric disorders, were enrolled in this prospective observational study. All patients were anesthetized with a standardized technique. After the return of spontaneous breathing, in addition to the standard monitoring, all patients were monitored with microstream EtCO2, is a portable bedside monitor that continuously monitors a patient’s EtCO2, RR, SpO2, PR and IPI. All those parameters and also Modified Aldrete Score (MAS) were recorded during the first 5 minutes immediately after neuromuscular blockage recovery and the first 10 minutes in the post anesthesia care unit (PACU) stay, at 1-min intervals. Supplemental oxygen requirement, any interventions improving the patency of airway and any complications such as apnea, bradypnoea, tachypnoea etc. were also recorded.
Results: There were 1088 IPI readings ranging from 1 to 10. IPI values during 5 minutes of recovery period were significantly lower in the respiratory intervention group, and also significantly low in patients who needed supplement oxygen in the PACU. Additionally, significant correlations were found between IPI and MAS or SpO2 during follow-up in PACU.
Conclusions: The IPI monitorization can be useful over the standard monitorization in terms of better evaluation of respiratory status, and also provide to make decision about PACU recovery, after ECT.

Keywords

Integrated pulmonary index, end-tidal carbon dioxide, electroconvulsive therapy, Modified Aldrete Score.

Project Number

This study was approved by the Institutional Investigation and Ethics Committee with the approval number of 12/90 in July 2019 and conducted at Cukurova University in Turkey.

Thanks

This manuscript has not been supported any external funding. The author of this article would like to thank everyone who played a role in carrying out this research.

The Value of Integrated Pulmonary Index Monitoring After Electroconvulsive Therapy

Abstract

Amaç: Entegre Pulmoner İndeks (IPI), hastanın genel ventilasyon durumunu basitçe göstermek için, ticari olarak temin edilebilen bir monitör tarafından ölçülen 4 ana parametreyi end-tidal karbondioksit (EtCO2), solunum sayısı (SS), oksijen satürasyonu (SpO2) ve nabız hızı (PR) entegre eden bir algoritmadır. IPI, hastanın solunumunu değerlendirerek ek klinik değerlendirme veya müdahale ihtiyacının belirlenmesini sağlar. Bu çalışmanın amacı, elektrokonvülsif tedaviden (EKT) sonra solunum durumunun ve anesteziden derlenmenin değerlendirilmesinde IPI monitörünün rolünü incelemekti.
Gereç ve Yöntemler: Bu prospektif gözlemsel çalışmaya, 18 ile 65 yaş arası, çeşitli psikiyatrik bozukluklar nedeniyle EKT uygulanan toplam 64 hasta dahil edildi. Tüm hastalara standart bir teknikle anestezi uygulandı. Spontan solunum geri döndükten sonra, standart izlemeye ek olarak tüm hastalar, hastanın EtCO2, SS, SpO2, PR ve IPI değerlerini sürekli olarak gösteren portatif bir hasta başı monitörü olan mikro akış EtCO2 ile izlendi. Tüm bu parametreler ve ayrıca Modifiye Aldrete Skoru (MAS), nöromusküler blokajın ortadan kalkmasından sonraki ilk 5 dakikasında ve anestezi sonrası bakım ünitesindeki (PACU) kalış süresinin ilk 10 dakikasında 1 dakikalık aralıklarla kaydedildi. Ek oksijen ihtiyacı, hava yolu açıklığını artırıcı girişimler ve apne, bradipne, takipne vb. komplikasyonlar kaydedildi.
Bulgular: Toplam, 1 ile 10 arasında değişen 1088 IPI değeri kaydedildi. IPI değerleri derlenme döneminin ilk 5 dakikalık süresinde solunum müdahalesi gereken grupta ve PACU'da da ek oksijen ihtiyacı olan hastalarda anlamlı derecede düşüktü. Ek olarak, PACU'da takiplerinde IPI ile MAS veya SpO2 arasında anlamlı korelasyonlar bulundu.
Sonuç: IPI monitörizasyonu, EKT sonrasında solunum durumunun daha iyi değerlendirilmesi açısından standart monitörizasyona göre daha faydalı olabilir; ayrıca PACU’da derlenmeyi değerlendirmeyi sağlayabilir.

Keywords

Elektrokonvülsif tedavi, entegre pulmoner indeks, end-tidal karbondioksit, Modifiye Aldrete Skoru., Integrated pulmonary index, end-tidal carbon dioxide, electroconvulsive therapy, Modified Aldrete Score.

Project Number

This study was approved by the Institutional Investigation and Ethics Committee with the approval number of 12/90 in July 2019 and conducted at Cukurova University in Turkey.

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