The Value of Integrated Pulmonary Index Monitoring After Electroconvulsive Therapy

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.