Normobaric oxygen therapy in acute ischemic stroke: A pilot study in Indian patients

Abstract

Purpose:Clinical and radiological assessment of effects of normobaric high-flow oxygen therapy in patients with acute ischemic stroke (AIS).Materials and Methods:Patients with anterior circulation ischemic strokes presenting within 12 h of onset, ineligible for intravenous thrombolysis, an National Institute of Health Stroke Scale (NIHSS) score of >4, a mean transit time (MTT) lesion larger than diffusion-weighted image (DWI) (perfusiondiffusion mismatch), and an evidence of cortical hypoperfusion on magnetic resonance imaging (MRI) were included into the trial. Active chronic obstructive pulmonary disease (COPD), requirement of >3/L min oxygen delivery to maintain SaO2 > 95%, rapidly improving neurological deficits, pregnancy, contraindications to MRI, or unstable medical conditions were excluded. The experimental group received humidified oxygen at flow rates of 10 L/min for 12 h. The NIHSS, modified Rankin Score (mRS), Barthel Index (BI) were measured at 0, 1, 7 day of admission and at 3 months follow-up. MRI with DWI/PWI was performed at admission, 24 h later and at 3 months follow-up.Results:Of 40 patients (mean age = 55.8 years ± 13.2) (range, 26–82), 20 patients were randomized to normobaric oxygen (NBO). The mean NIHSS in NBO and control groups were 14.25 and 12.7 at admission which decreased to 11.6 and 9.5 on the seventh day, and 9.4 and 9.05 at 3 months, respectively. The mean mRS (3.7/3.7) and BI (58.2/53.9) in NBO and control groups improved to 2/2.2 and 73.05/73.8 at the end of 3 months, respectively.Conclusions:NBO did not improve the clinical scores of stroke outcome in Indian patients with AIS.

BTS guideline for oxygen use in adults in healthcare and emergency settings

“…A small randomised trial of high-concentration oxygen therapy (10 L/min) in non-hypoxaemic patients (n=40) showed no clinical benefit339 and a study of very high-flow oxygen (45 L/min) was terminated in 2009 after enrolling 85 patients because of excess mortality in the hyperoxaemia group (40% vs 17%), the full report had not yet been published when this guideline was prepared 340. Finally, an observational study reported increased mortality associated with hyperoxaemia in ventilated patients with stroke on ICUs 341…”

Hypoxia after stroke: a review of experimental and clinical evidence

“…After enrolment of 85 patients, the study was terminated early due to an imbalance of deaths favouring the control arm, though it is noted that the excess in mortality in the treatment group was not considered related to the treatment by an external blinded assessor. An Indian study [81] enrolled 40 patients within 12 h of an acute anterior circulation ischaemic stroke and a National Institute Stroke Scale of more than 4 to receive either 10 L/min for 12 h via face mask in the treatment group versus room air or 2 L/min to keep oxygen saturation above 95%. There was no significant difference in NIHSS, modified Rankin or Barthel index scores between the two groups.…”

Republished: Society for Neuroscience in Anesthesiology and Critical Care Expert Consensus Statement: Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke*

“…No benefit, decreased survival, better neurological recovery as well as transient improvement of clinical function have all been reported to be associated with administration of supplemental oxygen. [35][36][37] There are no data specific to management of ventilation and end-tidal CO2 under GA for endovascular treatment of AIS. Existing data in stroke patients suggest that hypocapnia is associated with poor prognosis in stroke.…”