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Background <p>The increasing clinical demand for electroconvulsive therapy (ECT) highlights specific challenges in anaesthetic management, particularly the reliance on continuous mask ventilation. Bilevel positive airway pressure (BPAP) provides automated, hands-free ventilatory support and may enhance efficiency. This study aims to compare the impact of BPAP versus face mask ventilation on procedural turnover time during ECT.</p> Methods <p>In this single-blind, randomized controlled trial, 110 patients were enrolled with a history of at least two prior ECT sessions. Participants were randomly allocated to receive either BPAP or face mask ventilation. The primary outcome was the turnover time, defined as the duration from anaesthesia induction to entry into the post-anaesthesia care unit (PACU). Secondary outcomes included the total ECT duration, breathing and consciousness recovery times, incidence of hypoxemia (SpO2 &lt; 94% for &gt; 5&#xa0;s), adverse events and operator-centered measures, including upper limb discomfort, anxiety and satisfaction scores.</p> Results <p>The BPAP group demonstrated a significantly shorter median turnover time ccompared to the face mask group (332 [286–415] s vs. 426 [348–472] s; median difference 84&#xa0;s, 95% CI 44–119, <i>P</i> &lt; 0.001). No significant differences in the total ECT duration, breathing recovery time, consciousness recovery time, or incidence of hypoxemia. The incidence of anaesthesiologist-reported upper limb discomfort was lower in the BPAP group (<i>P</i> &lt; 0.001), and operator satisfaction scores were higher (<i>P</i> &lt; 0.001).</p> Conclusions <p>In patients with prior ECT experience, BPAP safely reduced procedural turnover time and significantly decreased the physical burden on anaesthesiologists compared to face mask ventilation. BPAP represents a viable strategy to improve workflow efficiency and operator comfort in high-volume ECT settings.</p> Trial registration <p>ChiCTR2100051837, the Chinese Clinical Trial, 20-211-006.</p> <p>Research registration number: ChiCTR2100051837, the Chinese Clinical Trial Registry.</p> <p>IRB number: [2021] 02-203-01, the Research Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.</p>

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Bilevel positive airway pressure reduces anaesthesiologist workload and turnover time in electroconvulsive therapy: a randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Yingyuan Li,
  • Xiaoyu Lin,
  • Jirong Yang,
  • Taojia Ran,
  • Jinyan Xu,
  • Ning Shen,
  • Pinjie Huang

摘要

Background

The increasing clinical demand for electroconvulsive therapy (ECT) highlights specific challenges in anaesthetic management, particularly the reliance on continuous mask ventilation. Bilevel positive airway pressure (BPAP) provides automated, hands-free ventilatory support and may enhance efficiency. This study aims to compare the impact of BPAP versus face mask ventilation on procedural turnover time during ECT.

Methods

In this single-blind, randomized controlled trial, 110 patients were enrolled with a history of at least two prior ECT sessions. Participants were randomly allocated to receive either BPAP or face mask ventilation. The primary outcome was the turnover time, defined as the duration from anaesthesia induction to entry into the post-anaesthesia care unit (PACU). Secondary outcomes included the total ECT duration, breathing and consciousness recovery times, incidence of hypoxemia (SpO2 < 94% for > 5 s), adverse events and operator-centered measures, including upper limb discomfort, anxiety and satisfaction scores.

Results

The BPAP group demonstrated a significantly shorter median turnover time ccompared to the face mask group (332 [286–415] s vs. 426 [348–472] s; median difference 84 s, 95% CI 44–119, P < 0.001). No significant differences in the total ECT duration, breathing recovery time, consciousness recovery time, or incidence of hypoxemia. The incidence of anaesthesiologist-reported upper limb discomfort was lower in the BPAP group (P < 0.001), and operator satisfaction scores were higher (P < 0.001).

Conclusions

In patients with prior ECT experience, BPAP safely reduced procedural turnover time and significantly decreased the physical burden on anaesthesiologists compared to face mask ventilation. BPAP represents a viable strategy to improve workflow efficiency and operator comfort in high-volume ECT settings.

Trial registration

ChiCTR2100051837, the Chinese Clinical Trial, 20-211-006.

Research registration number: ChiCTR2100051837, the Chinese Clinical Trial Registry.

IRB number: [2021] 02-203-01, the Research Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.