Effects of Normobaric Hyperoxia in Severe Acute Stroke: a Randomized Controlled Clinical Trial Study
Oxygen therapy might increase damaged tissue oxygenation, turn on the aerobic pathway, and save neurons from death and could improve clinical outcome of the patients with stroke and head trauma. Hyperbaric oxygen therapy is accompanied by some unfavorable effects. Results of normobaric oxygen therapy on clinical outcomes of patients with stroke were controversial up till now. This study was therefore designed to evaluate effects of normobaric hyperoxia on clinical outcomes of patients with severe acute stroke. A total of 52 consecutive patients with stroke who meet the inclusion criteria of the study were entered into this randomized controlled clinical trial. The patients in the case group underwent oxygen therapy with Venturi mask for first 12 hours of admission. The patients were examined for neurologic defects at the time of discharge and after six months using both Barthel and modified Rankin Scale (mRS) neurologic disability scoring systems. There was no significant sex difference between the two groups (P=0.5). There was no statistically significant difference between ischemic-hemorrhagic stroke constitutions of two groups (P=0.2). There were no significant difference in Barthel index scores of both groups at the time of discharge as well as the follow-up examination (P=0.7) According to the mRS scoring system, there was no difference between the patients of both groups at the time of admission (P= 0.8), however after treatment there was a significant difference between mRS scores of the treated group compared to the controls (P=0.04). According to the results of this study, normobaric oxygen therapy in the first 12 hours of accident could improve long time outcome of the patients with either ischemic or hemorrhagic stroke.
Willemse-van Son AH, Ribbers GM, Hop WC, et al. Community integration following moderate to severe traumatic brain injury: a longitudinal investigation. J Rehabil Med 2009;41(7):521-7.
De Keyser J, Sulter G, Luiten PG. Clinical trials with neuroprotective drugs in acute ischaemic stroke: are we doing the right thing? Trends in neurosciences 1999;22(12):535-40.
Tolias CM, Bullock MR. Critical appraisal of neuroprotection trials in head injury: what have we learned? NeuroRx 2004;1(1):71-9.
Glenn TC, Kelly DF, Boscardin WJ, et al. Energy dysfunction as a predictor of outcome after moderate or severe head injury: indices of oxygen, glucose, and lactate= metabolism. J Cereb Blood Flow Metab 2003;23(10):1239-50.
Hayakawa T, Kanai N, Kuroda R, et al. Response of cereborspinal fluid pressure to hyperbaric oxygenation. J Neurol 1971;34(5):580-6.
Rockswold SB, Rockswold GL, Zaun DA, et al. A prospective, randomized clinical trial to compare the effect of hyperbaric to normobaric hyperoxia on cerebral metabolism, intracranial pressure, and oxygen toxicity in severe traumatic brain injury. J Neurosurg 2010;112(5):1080-94.
Tolias CM, Reinert M, Seiler R, et al. Normobaric hyperoxia--induced improvement in cerebral metabolismand reduction in intracranial pressure in patients with severe head injury: a prospective historical cohort-matched study. J Neurosurg 2004;101(3):435-44.
Pellerin L, Magistretti PJ. Glutamate uptake into astrocytes stimulates aerobic glycolysis: a mechanism coupling neuronal activity to glucose utilization. Proc Natl Acad Sci U S Am 1994;91(22):10625-9.
Hutchinson PJ, Gupta AK, Fryer TF, et al. Correlation between cerebral blood flow, substrate delivery, and metabolism in head injury: a combined microdialysis and triple oxygen positron emission tomography study. J Cereb Blood Flow Metab 2002;22(6):735-45.
Ankarcrona M, Dypbukt JM, Bonfoco E, et al. Glutamateinduced neuronal death: a succession of necrosis or apoptosis depending on mitochondrial function. Neuron 1995;15(4):961-73.
Verweij BH, Muizelaar JP, Vinas FC, et al. Impaired cerebral mitochondrial function after traumatic brain injury in humans. J Neurosurg 2000;93(5):815-20.
Verweij BH, Muizelaar JP, Vinas FC, et al. Improvement in mitochondrial dysfunction as a new surrogate efficiency measure for preclinical trials: dose-response and timewindow profiles for administration of the calcium channel blocker Ziconotide in experimental brain injury. J Neurosurg 2000;93(5):829-34.
Menzel M, Doppenberg EM, Zauner A, et al. Increased inspired oxygen concentration as a factor in improved brain tissue oxygenation and tissue lactate levels after severe human head injury. J Neurosurg 1999;91(1):1-10.
Reinert M, Barth A, Rothen HU, et al. Effects of cerebral perfusion pressure and increased fraction of inspired oxygen on brain tissue oxygen, lactate and glucose in patients with severe head injury. Acta Neurochir 2003;145(5):341-9; discussion 349-50.
Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke 1999;30(8):1538-41.
Rusyniak DE, Kirk MA, May JD, et al. Hyperbaric oxygen therapy in acute ischemic stroke: results of the Hyperbaric Oxygen in Acute Ischemic Stroke Trial Pilot Study. Stroke 2003;34(2):571-4.
Ronning OM, Guldvog B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke 1999;30(10):2033-7.
Stiefel MF, Spiotta A, Gracias VH, et al. Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 2005;103(5):805-11.
Abate MG, Trivedi M, Fryer TD, et al. Early derangements in oxygen and glucose metabolism following head injury: the ischemic penumbra and pathophysiological heterogeneity. Neurocrit Care 2008;9(3):319-25.
Robertson CA, McCabe C, Gallagher L, et al. Stroke penumbra defined by an MRI-based oxygen challenge technique: 1. Validation using [14C]2-deoxyglucose autoradiography. J Cereb Blood Flow Metab 2011;31(8):1778-87.
Strong AJ, Dardis R. Depolarisation phenomena in traumatic and ischaemic brain injury. Adv Tech Stand Neurosurg 2005;30(1):3-49.
Dirnagl U, Iadecola C, Moskowitz MA. Pathobiology of ischaemic stroke: an integrated view. Trends Neurosci 1999;22(9):391-7.
Takano T, Tian GF, Peng W, et al. Cortical spreading depression causes and coincides with tissue hypoxia. Nat Neurosci 2007;10(6):754-62.
Kellert L, Herweh C, Sykora M, et al. Loss of Penumbra by Impaired Oxygen Supply? Decreasing Hemoglobin Levels Predict Infarct Growth after Acute Ischemic Stroke: Stroke: Relevant Impact of Hemoglobin, Hematocrit and Transfusion (STRAIGHT) - An Observational Study. Cerebrovasc Dis Extra 2012;2(1):99-107.
Kett-White R, Hutchinson PJ, Czosnyka M, et al. Multimodal monitoring of acute brain injury. Adv Tech Standards in neurosurgery 2002;27:87-134.
Chiu EH, Liu CS, Tan TY, et al. Venturi mask adjuvant oxygen therapy in severe acute ischemic stroke. Arch Neurol 2006;63(5):741-4.
Martin DS, Grocott MP. Oxygen therapy in critical illness: precise control of arterial oxygenation and permissive hypoxemia. Crit Care Med 2013;41(2):423-32.
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