Hyperbaric oxygen therapy for acute ischaemic stroke

Bennett, Michael H; Weibel, Stephanie; Wasiak, Jason; Schnabel, Alexander; French, Chris; Kranke, Peter

doi:10.1002/14651858.cd004954.pub3

Cited by 63 publications

(36 citation statements)

References 39 publications

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Section: Hyperbaric Oxygenmentioning

confidence: 99%

“…In addition, HBO is widely used as an adjunctive therapy for many conditions, such as diabetic ulcer healing, traumatic brain injury, and ischemic stroke. However, a recent meta-analysis of clinical trials for the latter three conditions found no conclusive evidence for benefit to the patient after HBO therapy (13,81,82).HBO treatment is relatively safe (83,84), and some studies have shown it has anti-inflammatory activity (85-87). These features support further research into HBO treatment as an adjunctive therapy candidate for a wide range of diseases (88).…”

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Pathophysiological Mechanisms in Gaseous Therapies for Severe Malaria

et al. 2016

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cOver 200 million people worldwide suffer from malaria every year, a disease that causes 584,000 deaths annually. In recent years, significant improvements have been achieved on the treatment of severe malaria, with intravenous artesunate proving superior to quinine. However, mortality remains high, at 8% in children and 15% in adults in clinical trials, and even worse in the case of cerebral malaria (18% and 30%, respectively). Moreover, some individuals who do not succumb to severe malaria present longterm cognitive deficits. These observations indicate that strategies focused only on parasite killing fail to prevent neurological complications and deaths associated with severe malaria, possibly because clinical complications are associated in part with a cerebrovascular dysfunction. Consequently, different adjunctive therapies aimed at modulating malaria pathophysiological processes are currently being tested. However, none of these therapies has shown unequivocal evidence in improving patient clinical status. Recently, key studies have shown that gaseous therapies based mainly on nitric oxide (NO), carbon monoxide (CO), and hyperbaric (pressurized) oxygen (HBO) alter vascular endothelium dysfunction and modulate the host immune response to infection. Considering gaseous administration as a promising adjunctive treatment against severe malaria cases, we review here the pathophysiological mechanisms and the immunological aspects of such therapies. Malaria exerts a heavy burden over human populations, with an estimated 124 to 283 million cases and 584,000 deaths in 2013 (1). Currently, intravenous (i.v.) artesunate is the treatment of choice in severe malaria cases in children and adults (2, 3). However, despite the efficacy of intravenous artesunate, mortality from severe malaria in general and from cerebral malaria (CM) in particular remains high, at 18% for African children and 30% for adults in Southeast Asia (2, 3). In addition, 11% of children who survive CM show severe neurological deficits, and up to 25% can maintain long-term cognitive deficits (4-8). Therefore, strategies focusing only on parasite killing may not be sufficient to prevent neurological complications and deaths related to severe malaria. Accordingly, adjunctive therapies-defined as therapies administered in combination with antiparasitic drugs that modify pathophysiological processes caused by malaria-are being sought in order to mitigate complications caused by severe malaria (9). Considering the fact that currently administered antimalarial drugs often take 12 to 18 h to kill parasites, adjunctive therapies could reduce the risk of neurocognitive sequelae and mortality, particularly in patients with CM (10).Different adjunctive therapies have been or are being tested, including treatments aimed at modulation of the immune response to infection (dexamethasone, intravenous immunoglobulin), reduction of iron burden, reduction of oxidative stress, modulation of the prothrombotic state, and reduction of parasitemia (blood transfusion), amon...

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Section: Hyperbaric Oxygenmentioning

confidence: 99%

mentioning

confidence: 99%

Pathophysiological Mechanisms in Gaseous Therapies for Severe Malaria

et al. 2016

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Section: ■ Introductionmentioning

confidence: 99%

“…Thus, plasma and body fluids will have an increased O 2 concentration, regardless of the hemoglobin saturation, depending on the integrity of vascular circulation 7,8 .…”

Section: ■ Introductionmentioning

confidence: 99%

“…Hyperbaric oxygenation (HBO) involves the supply of 100% oxygen (O 2 ) in an environment with atmospheric pressure ranging from two to three absolute atmospheres (ATA). Thus, plasma and body fluids will have an increased O 2 concentration, regardless of the hemoglobin saturation, depending on the integrity of vascular circulation 7,8 .The RT-qPCR (reverse transcriptase quantitative polymerase chain reaction) technique is a technological tool that allows the reliable and rapid quantitative evaluation of the expression of large numbers of genes. We selected genes related to oxidative stress and the antioxidant defense for assessment in isogenic mice [9][10][11] .…”

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Hyperbaric oxygenation and the genic expression related to oxidative stress in the heart of mice during intestinal ischemia and reperfusion

Neto

Ikejiri²,

Bertoletto³

et al. 2017

Acta Cir. Bras.

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Hyperbaric oxygenation and the genic expression related to oxidative stress in the heart of mice during intestinal ischemia and reperfusion 1 3-Experimental SurgeryActa Cir Bras. 2017;32(11):913-923 AbstractPurpose: To investigate the effects of hyperbaric oxygenation (HBO) on intestinal ischemia and reperfusion (IR) injury, we evaluated the expression of 84 genes related to oxidative stress and the antioxidant response in mouse hearts. Methods: Four groups were subjected to 60 minutes of intestinal ischemia followed by 60 minutes of reperfusion: IRG, ischemia and reperfusion group without HBO; HBO-IG, which received HBO during ischemia; HBO-RG, which received HBO during reperfusion; and HBO-IRG, which received HBO during ischemia and reperfusion. The control group (CG) underwent anesthesia and laparotomy and was observed for 120 minutes. The (RT-qPCR) method was applied. Genes with expression levels three times below or above the threshold cycle were considered significantly hypoexpressed or hyperexpressed, respectively (Student's t-test p<0.05).Results: Eight genes (9.52%) were hyperexpressed in the IRG. When the HBO groups were compared to the IRG, we found a decrease in the expression of eight genes in the HBO-IG, five genes in the HBO-RG, and seven genes in the HBO-IRG. Conclusion:The reduction in the expression of genes related to oxidative stress and antioxidant defense following HBO in mouse hearts resulting from intestinal IR injury was more favorable during the ischemic period than during the reperfusion period. Thirty male isogenic mice (C57BL/6) from the Center for the Development of Experimental Models in Medicine and Biology (CEDEME -UNIFESP) were housed under controlled temperature and light conditions with a 12:12 hour light: dark cycle and free access to water and pelleted rations for up to 6 hours before the surgical procedures. Anesthetic and surgical proceduresThe mice were anesthetized intramuscularly with 44 mg.kg -1 of ketamine hydrochloride solution (Ketamina AgenerUnião Química, São Paulo), 2.5 mg.kg -1 of xylazine hydrochloride (Calmium -União Química, São Paulo), and 0.75 mg.kg -1 of acepromazine (Acepran -Rhobifarma, Hortolândia-SP). The control group (CG) was anesthetized, subjected to laparotomy without occlusion of the superior mesenteric vessels, and observed for 120 minutes. The IR group (IRG) was subjected to 60 minutes of superior mesenteric artery occlusion, followed by 60 minutes of reperfusion. Three groups received HBO as follows: during ischemia (HBO-IG), during reperfusion (HBO-RG), and during ischemia and during reperfusion (HBO-IRG). Material collection procedureSamples were taken from the small intestine and the heart. The fragments of the hearts and the intestinal segments were washed with saline solution, wrapped in labeled aluminum foil, immersed in liquid nitrogen (-196°C), and sent to the Laboratory ■ IntroductionIschemia-reperfusion (IR) injuries with cellular alterations and humoral disorders lead to an imbalance in homeostasis 1 . These injuries occur as a resu...

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An overview of protective strategies against ischemia/reperfusion injury: The role of hyperbaric oxygen preconditioning

et al. 2018

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IntroductionIschemia/reperfusion (I/R) injury, such as myocardial infarction, stroke, and peripheral vascular disease, has been recognized as the most frequent causes of devastating disorders and death currently. Protective effect of various preconditioning stimuli, including hyperbaric oxygen (HBO), has been proposed in the management of I/R.MethodsIn this study, we searched and reviewed up‐to‐date published papers to explore the pathophysiology of I/R injury and to understand the mechanisms underlying the protective effect of HBO as conditioning strategy.ResultsAnimal study and clinic observation support the notion that HBO therapy and conditioning provide beneficial effect against the deleterious effects of postischemic reperfusion. Several explanations have been proposed. The first likely mechanism may be that HBO counteracts hypoxia and reduces I/R injury by improving oxygen delivery to an area with diminished blood flow. Secondly, by reducing hypoxia–ischemia, HBO reduces all the pathological events as a consequence of hypoxia, including tissue edema, increased affective area permeability, postischemia derangement of tissue metabolism, and inflammation. Thirdly, HBO may directly affect cell apoptosis, signal transduction, and gene expression in those that are sensitive to oxygen or hypoxia. HBO provides a reservoir of oxygen at cellular level not only carried by blood, but also by diffusion from the interstitial tissue where it reaches high concentration that may last for several hours, improves endothelial function and rheology, and decreases local inflammation and edema.ConclusionEvidence suggests the benefits of HBO when used as a preconditioning stimulus in the setting of I/R injury. Translating the beneficial effects of HBO into current practice requires, as for the “conditioning strategies”, a thorough consideration of risk factors, comorbidities, and comedications that could interfere with HBO‐related protection.

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Hyperbaric oxygen therapy for acute ischaemic stroke

Cited by 63 publications

References 39 publications

Pathophysiological Mechanisms in Gaseous Therapies for Severe Malaria

Pathophysiological Mechanisms in Gaseous Therapies for Severe Malaria

Hyperbaric oxygenation and the genic expression related to oxidative stress in the heart of mice during intestinal ischemia and reperfusion

An overview of protective strategies against ischemia/reperfusion injury: The role of hyperbaric oxygen preconditioning

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