Hypnosis can significantly improve patients' tolerance of masks to help them breathe when they are suffering from acute respiratory failure, according to a pilot study presented at the European Emergency Medicine Congress today (Monday).
People who come to hospital with breathing problems are often given non-invasive ventilation (NIV) via a mask and tubes connected to a machine in order increase the amount of oxygen in their blood and lower carbon dioxide levels. However, some patients are unable to tolerate a tight-fitting mask over their mouth and nose and have to be sedated or given anti-anxiety medication.
Dr Tobi Hamza, a resident emergency medicine doctor at the Mohammed V Military Teaching Hospital (HMIMV) in Rabat, Morocco, told the Congress: "We decided to conduct this study in response to the significant anxiety, discomfort, and poor tolerance often observed in patients undergoing non-invasive ventilation, particularly those with acute respiratory distress. Given the increasing interest in non-pharmacological techniques to improve patient comfort and compliance, we wanted to explore whether medical hypnosis could improve NIV tolerance and outcomes."
Acute respiratory failure is a medical emergency and occurs when the lungs are unable to take in enough oxygen and remove carbon dioxide. There are a number of causes, including heart failure, lung diseases, such as chronic obstructive pulmonary disease (COPD) and pneumonia, infections and injuries to the chest or ribs.
Between December 2023 and May 2024, Dr Hamza and colleagues recruited 20 patients who came into the HMIMV emergency department with acute respiratory distress to a prospective pilot study. They randomised them into two groups: ten patients received the standard care of NIV and anti-anxiety medication if needed – the control group; a further ten patients received a hypnosis session and NIV.
The hypnosis session consisted of a calming induction phase using voice guidance, breathing synchronisation and visual imagery; a deepening phase to reduce anxiety and enhance dissociation from physical discomfort; and a therapeutic suggestion phase, aiming to promote feelings of safety, trust in the treatment and cooperation with the mask. A doctor trained in medical hypnosis conducted all the sessions."
Dr. Tobi Hamza, Resident Emergency Medicine Doctor, Mohammed V Military Teaching Hospital (HMIMV)
The researchers assessed how well the patients tolerated the masks using a comfort score with a scale from 0 to 10, by assessing changes in oxygen, carbon dioxide and acidity levels (pH) in the arterial blood after one and four hours, any requirement for sedation and anti-anxiety medication, and whether or not NIV had to be discontinued [2].
"Our most significant result was a substantial improvement in NIV tolerance in the hypnosis group," said Dr Hamza. "Eight out of ten patients, 80%, in the hypnosis group successfully completed non-invasive ventilation sessions without requiring sedation or switching to invasive ventilation, compared to only five out of ten, 50%, in the control group.
"We also observed a reduction in agitation and respiratory distress scores, shorter duration of emergency room stay, and reduced need for anti-anxiety medication. Clinical efficacy was improved too. After four hours, we saw greater reductions in carbon dioxide in the blood and the acidity levels returned to normal. We were positively surprised by the magnitude of the difference. It confirmed that hypnosis could be a powerful complementary tool in emergency respiratory care, improving NIV tolerance, reducing patient distress and potentially improving outcomes. For clinicians it offers a low-cost, non-invasive, drug-free adjunct to support respiratory care."
Patients in the hypnosis group gave a higher comfort score: 7.5 out of ten, compared to 4.3 in the control group.
"To our knowledge, this is one of the first prospective studies evaluating hypnosis as a supportive technique during NIV in emergency settings. While hypnosis has been explored in pain, procedural anxiety and chronic disease management, its application in acute respiratory distress with NIV is still very novel. Although it was a small study, the findings suggest a substantial clinical benefit and we are conducting a larger, multi-centre study to validate our findings and explore the long-term impact of hypnosis on outcomes, such as hospital stay, intubation rate and mortality," he concluded.
A strength of the study is its prospective design in a real-world emergency department with an emergency doctor trained in hypnosis. Limitations include that it was a single-centre study, it was difficult to obtain consent for hypnosis, especially when it would jeopardise immediate vital prognoses or patients were confused, and patients were excluded from the study if they presented as an extreme emergency; a doctor trained in hypnosis administered it to patients, which might limit the generalisability of the findings until more staff are trained in the technique; and the doctors and patients were not 'blinded' to which patients received which treatment.
Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: "We do know that in the setting of non-invasive ventilation, verbal guidance is of utmost importance to ensure therapy adherence, especially in emergency settings. Hypnosis is a step further in intensifying the interaction, and this study suggests that hypnosis not only can help patients to tolerate non-invasive ventilation more easily and make them comfortable, but also can improve the clinical efficacy of the ventilation. This deserves further investigation in larger groups of patients."
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