Association Between Hyperoxia and Mortality After Stroke

Rincón, Fred; Kang, Joon Y.; Maltenfort, Mitchell; Vibbert, Matthew; Urtecho, Jacqueline; Athar, Mohammad; Jallo, Jack; Pineda, Carissa; Tzeng, Diana; McBride, William; Bell, Rodney

doi:10.1097/ccm.0b013e3182a27732

Cited by 203 publications

(164 citation statements)

References 33 publications

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“…Hyperoxia is also found to worsen neurological outcomes in a rat model of traumatic brain injury with hemorrhagic shock [47]. Other clinical studies have confirmed that hyperoxia is independently correlated with long-term poor neurological outcomes and in-hospital mortality among patients with brain injury [48, 49]. Therefore, excessive oxygen is a major factor mediating Hb-induced neurotoxicity.…”

Section: Discussionmentioning

confidence: 99%

An Intersectional Study of LncRNAs and mRNAs Reveals the Potential Therapeutic Targets of Buyang Huanwu Decoction in Experimental Intracerebral Hemorrhage

Cui

Liu

et al. 2018

Cell Physiol Biochem

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Background/Aims: Both experimental and clinical studies have revealed satisfactory effects of the traditional Chinese formula Buyang Huanwu decoction (BYHWD) in improving post-intracerebral hemorrhage (ICH) neurological deficiencies. However, the multifaceted mechanisms of BYHWD in ICH treatment are not comprehensively understood. The present study explored various therapeutic targets of BYHWD by using lncRNA and mRNA transcriptomics. Methods: LncRNA and mRNA microarrays were used to identify differentially expressed genes. ICH-induced upregulated genes (ICH vs sham) and BYHWD-induced downregulated genes (BYHWD vs ICH) were first identified. The intersection between these 2 sets was determined to identify ICH-induced highly expressed genes that were reversed by BYHWD. Then, the genes downregulated after ICH and the genes upregulated after BYHWD treatment were used to generate another set of intersections. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were subsequently performed to determine relative biological functions and signaling transduction pathways according to genes within the intersections. Quantitative real-time PCR was used to validate changes in gene expression observed using the microarray. Finally, a lncRNA-mRNA co-expression network was established to identify links among the genes within the intersections. Results: A total of 18 differentially expressed lncRNAs and 33 differentially expressed mRNAs were identified using 2 lncRNA arrays (ICH vs sham and BYHWD vs ICH). The altered genes were enriched in the hemoglobin complex, oxygen transport and oxygen transporter and were closely associated with pyruvate metabolism. The co-expression network consisted of 53 nodes and 595 connections (308 positive interactions and 287 negative interactions). Conclusion: The hemoglobin complex, oxygen transport, oxygen transporter activity and pyruvate metabolism are possible therapeutic targets of BYHWD in ICH treatment. The present study provides the basis and direction for future investigations to explore the mechanisms by which BYHWD protects against long-term neurological deficiencies after ICH.

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Section: Discussionmentioning

confidence: 99%

An Intersectional Study of LncRNAs and mRNAs Reveals the Potential Therapeutic Targets of Buyang Huanwu Decoction in Experimental Intracerebral Hemorrhage

Cui

Liu

et al. 2018

Cell Physiol Biochem

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“…Recently, randomized controlled trials have commenced to clarify the safety, feasibility and efficacy of targeting different oxygenation targets for mechanically ventilated ICU patients (Australian New Zealand clinical trials registry; ACTRN 12613000505707), patients following cardiac surgery (ACTRN 12613001322729), patients with traumatic brain injury (NCT01201291), patients with acute myocardial infarction (15), and stroke (6). While it is premature to change practice until the trial results are known, it has been of value to evaluate the impact of practice change on our clinicians.…”

Section: Discussionmentioning

confidence: 99%

Intensive Care Clinicians’ Attitudes and Self-Reported Practice of Conservative Oxygen Therapy

et al. 2015

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Background: Conservative oxygen therapy (COT) targets a SpO2 of 90 -92% using the lowest possible FiO2 for mechanically ventilated (MV) adult patients. Conservative oxygen therapy aims to maintain adequate oxygenation while avoiding the harmful effects of hyperoxaemia. However, a lower SpO2 target during MV is recognised as challenging in current clinical norms. Objectives: We sought to describe intensive care clinicians' opinion and self-reported practice of conservative oxygen therapy. Methods: The research tool was a multi-choice questionnaire of intensive care clinicians working at 10 affiliated metropolitan tertiary hospitals from January-April, 2014. Results: Four hundred and twelve (84%) staff members responded to the survey. Of these, 91% (375) were intensive care nurses and 9% (37) were medical doctors. A majority of respondents (86%, 356/412) considered oxygen-related lung injury as "Yes, a major concern". Most respondents, 85% (351/412), felt COT was easy to perform and a few respondents, 6% (23/412), considered performing COT to be stressful. More than 90% of the respondents reported not performing more arterial blood gases to monitor PaO2 during COT and essentially all (98%) indicated a desire to perform COT. Free text comments indicated COT as a challenge to current practice and expressed a strong desire to avoid inadvertent hypoxaemia. Conclusions: Intensive care clinicians varied in their opinion and self-reported practice of conservative oxygen therapy and were genuinely concerned about unintended physiological consequences related to targeting low SpO2 values. We recommend conservative oxygen therapy to be implemented cautiously in conjunction with further evaluation of its impact on outcomes for patients and the perceptions of clinicians.

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“…This has global consequences because the inflammatory cascade initiated by ischemia-reperfusion injury causes remote damage to other organ systems. 61 Mounting clinical and preclinical evidence indicates that hyperoxia during cardiopulmonary bypass, 58 following cardiac arrest, 62 liver ischemia, 63 and brain ischemia, 64 provokes multi-organ damage, suggesting that hyperoxia should be avoided whenever possible. A meta-analysis of preclinical studies of cardiac arrest 65 found that resuscitation with an F IO 2 of 1 sustained for 60 min after the return of spontaneous circulation produced significantly greater neuronal damage and worse neurologic deficits compared with an F IO 2 of 0.21 or titrated to maintain normal arterial oxygenation.…”

Section: Systemic Effects Of Hyperoxiamentioning

confidence: 99%

“…These data often include subjects who are not mechanically ventilated, but the risk of worsening ischemia/reperfusion injury in stoke is compelling. 64,112,113 A meta-analysis by Rincon and co-workers 64 demonstrated a direct negative effect of hyperoxia on outcomes in mechanically ventilated subjects following stroke. In fact, the authors concluded: "In ventilated stroke patients admitted to the ICU, arterial hyperoxia was independently associated with in-hospital death as compared with either normoxia or hypoxia.…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Should Oxygen Therapy Be Tightly Regulated to Minimize Hyperoxia in Critically Ill Patients?

Kallet

Branson

2016

Respir Care

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Oxygen is both lifesaving and toxic. Appropriate use of oxygen aims to provide a balance between the two effects. Although local oxygen toxicity to the lung is well accepted, recent evidence has called into question the negative consequences of hyperoxemia in other organ beds. Hyperoxia following cardiac arrest, traumatic brain injury, and stroke has been shown to worsen outcomes. The role of hyperoxemia in mechanically ventilated patients, in the face of non-toxic inspired oxygen concentrations, is less clear. This paper will review the data for and against the use of conservative oxygen targets and the avoidance of hyperoxemia in mechanically ventilated patients. Key words: hyperoxia; hyperoxic acute lung injury; lung protective ventilation; oxygen toxicity; reactive oxygen species; ventilator-induced lung injury. [Respir Care 2016;61(6):801-817.

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Association Between Hyperoxia and Mortality After Stroke

Cited by 203 publications

References 33 publications

An Intersectional Study of LncRNAs and mRNAs Reveals the Potential Therapeutic Targets of Buyang Huanwu Decoction in Experimental Intracerebral Hemorrhage

An Intersectional Study of LncRNAs and mRNAs Reveals the Potential Therapeutic Targets of Buyang Huanwu Decoction in Experimental Intracerebral Hemorrhage

Intensive Care Clinicians’ Attitudes and Self-Reported Practice of Conservative Oxygen Therapy

Should Oxygen Therapy Be Tightly Regulated to Minimize Hyperoxia in Critically Ill Patients?

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