Association of Early Oxygenation Levels with Mortality in Acute Ischemic Stroke – A Retrospective Cohort Study

Akça, Ozan; Nichols, James; Stewart, Benjamin; Elliott, Conner; Remmel, Kerri; Lenhardt, Rainer

doi:10.1016/j.jstrokecerebrovasdis.2019.104556

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…In the abovementioned study, time-weighted mean SpO 2 levels between 93% and 98% were associated with the lowest mortality rates. Patients with a time-weighted mean SpO 2 of less than 92% had the highest mortality rate, but this difference in mortality was not statistically significant [21].…”

Section: Discussionmentioning

confidence: 80%

“…In contrast, Akca et al showed that lower mean SpO 2 / /FiO 2 levels (and age and initial NIHSS score) were correlated with increased mortality within the first few hours after AIS onset (although for the record, the authors analysed only the mortality rate and did not assess patients' functional status as an outcome) [21].…”

Section: Discussionmentioning

confidence: 99%

“…The time on the Spacelabs monitoring system and ECG recorder were coordinated at 10pm each night during the study. The time-weighted SpO 2 desaturation was assessed according to the methodology used by Akca et al [21], and oxygen saturation variability (SpO 2 fluctuations) was assessed according to Zhang et al [22].…”

Section: Oxygenation Datamentioning

confidence: 99%

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Association between nocturnal oxygen desaturation and ischaemic stroke outcomes

Wojtasz¹,

Tomski

Kaźmierski

2022

Neurol Neurochir Pol.

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Clinical rationale for the study. This study aimed to assess the association between nocturnal hypoxemia and early acute ischaemic stroke (AIS) outcomes in patients without oxygen supplementation.Material and methods. One hundred and six AIS patients consecutively admitted to the stroke unit were included in this study. Baseline demographic and medical data and arterial blood saturation (SpO 2 ) measurements during night-sleep (from 10pm to 6am) were examined for their association with stroke outcomes, including the National Institutes of Health Stroke Scale (NIHSS) score on the 7th day or differences between the NIHSS score on the 1st day and the 7th day after stroke onset.Measurements of SpO 2 were made using a pulse oximeter of the Spacelabs Medical Inc. (USA) monitoring system, and the number of apnoea episodes and their duration were recorded by ECG Holter with respiration monitoring (CardioMem®, Getamed, GE).Results. The study showed that age (Spearman's r = 0.207, p = 0.033) and parameters attributable to anaemia (RBC r = -0.205, p = 0.035, Hb r = -0.225, p = 0.02 and HCT r = -0.196, p = 0.044), atrial fibrillation and ischaemic changes in both brain hemispheres (p = 0.023 and 0.01, respectively) were correlated with the study outcomes.In terms of saturation parameters, we demonstrated that the 'total desaturation burden' (i.e. [100% minus actual measured SpO 2 %] x apnoea duration) and multiple apnoeas of longer than 20 seconds were correlated with worse functional outcomes. Measures of shorter desaturation episodes (i.e. SpO 2 oxygen desaturation index (ODI) at 3% and 4%, and time-weighted desaturations below the determined thresholds (SpO 2 from 95% to 85%) demonstrated non-significant associations with the study outcomes. Conclusions and clinical implications.This study demonstrated that long-lasting desaturation episodes during the night, depicted by the 'total desaturation burden' , were correlated with worse functional outcomes in AIS, while measures of shorter desaturation episodes were not correlated. In future clinical trials, indications for oxygen supplementation should include the methodology of personalised medicine and introduce individual approaches based on specially formulated, novel multifactorial algorithms.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Association between nocturnal oxygen desaturation and ischaemic stroke outcomes

Wojtasz¹,

Tomski

Kaźmierski

2022

Neurol Neurochir Pol.

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“…In acute critical situations during anesthesia, e.g., when a technical problem with ventilation occurs, a high oxygen concentration also buys time to solve the problem. However, the effects of oxygen are both dose-and organ-dependent [13][14][15][16]. While oxygenation targets in the intensive care unit (ICU) setting have not been adequately defined, the use of high FiO 2 in the first 24 h after ICU admission has been linearly associated with in-hospital mortality [17].…”

Section: Introductionmentioning

confidence: 99%

Practice of oxygen use in anesthesiology – a survey of the European Society of Anaesthesiology and Intensive Care

Scharffenberg

Weiss²,

Wittenstein³

et al. 2022

BMC Anesthesiol

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Background Oxygen is one of the most commonly used drugs by anesthesiologists. The World Health Organization (WHO) gave recommendations regarding perioperative oxygen administration, but the practice of oxygen use in anesthesia, critical emergency, and intensive care medicine remains unclear. Methods We conducted an online survey among members of the European Society of Anaesthesiology and Intensive Care (ESAIC). The questionnaire consisted of 46 queries appraising the perioperative period, emergency medicine and in the intensive care, knowledge about current recommendations by the WHO, oxygen toxicity, and devices for supplemental oxygen therapy. Results Seven hundred ninety-eight ESAIC members (2.1% of all ESAIC members) completed the survey. Most respondents were board-certified and worked in hospitals with > 500 beds. The majority affirmed that they do not use specific protocols for oxygen administration. WHO recommendations are unknown to 42% of respondents, known but not followed by 14%, and known and followed by 24% of them. Respondents prefer inspiratory oxygen fraction (FiO2) ≥80% during induction and emergence from anesthesia, but intraoperatively < 60% for maintenance, and higher FiO2 in patients with diseased than non-diseased lungs. Postoperative oxygen therapy is prescribed more commonly according to peripheral oxygen saturation (SpO2), but shortage of devices still limits monitoring. When monitoring is used, SpO2 ≤ 95% is often targeted. In critical emergency medicine, oxygen is used frequently in patients aged ≥80 years, or presenting with respiratory distress, chronic obstructive pulmonary disease, myocardial infarction, and stroke. In the intensive care unit, oxygen is mostly targeted at 96%, especially in patients with pulmonary diseases. Conclusions The current practice of perioperative oxygen therapy among respondents does not follow WHO recommendations or current evidence, and access to postoperative monitoring devices impairs the individualization of oxygen therapy. Further research and additional teaching about use of oxygen are necessary.

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Anesthesia for Acute Ischemic Stroke: Updates and Ongoing Debates

Crosby

Davis

2021

Curr Anesthesiol Rep

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Association of Early Oxygenation Levels with Mortality in Acute Ischemic Stroke – A Retrospective Cohort Study

Cited by 5 publications

References 30 publications

Association between nocturnal oxygen desaturation and ischaemic stroke outcomes

Association between nocturnal oxygen desaturation and ischaemic stroke outcomes

Practice of oxygen use in anesthesiology – a survey of the European Society of Anaesthesiology and Intensive Care

Anesthesia for Acute Ischemic Stroke: Updates and Ongoing Debates

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