Hypoxaemia in Acute Stroke Is Frequent and Worsens Outcome

Abstract

Background: Hypoxaemia in the acute phase of stroke might damage the ischaemic penumbra and worsen clinical outcome. We determined the frequency of hypoxaemia on admission with stroke and assessed whether it was related to outcome. Methods: We measured arterial oxygen saturation (SaO₂) and breathing effort with portable monitoring equipment in a large cohort of acute stroke patients, continually from arrival at hospital, during interdepartment transfer, in imaging and on the ward. Patients received best medical care according to current guidelines. Baseline neurological examination and 3-month outcome (Modified Rankin Scale) were assessed blind to other data. Hypoxaemia was defined as SaO₂ <90% for ≧10% of each assessment stage. Results: Mean SaO₂ was lowest during transfers (p < 0.01), but hypoxaemia was common in all assessment stages. Patients with hypoxaemia (30/153, 20%) were more likely to have a pre-existing respiratory disease on admission than those without hypoxaemia (p < 0.04). More patients with hypoxaemia (40%) died than those without hypoxaemia (20%) (hazard ratio, 2.0; 95% CI, 1.0–4.1), though after adjusting for National Institute of Health Stroke Scale and age this association was not statistically significant (hazard ratio, 1.5; 95% CI, 0.7–3.1). There were similar numbers of dependent survivors in both groups. Conclusion: Hypoxaemia during acute stroke assessment was associated with increased risk of death. Although SaO₂ is lower during transfers, hypoxaemia occurs in all stages of the admission process. Further research is necessary to determine whether strategies to avoid hypoxaemia during acute assessment improve stroke survival.

Safety and Effect of Metoclopramide to Prevent Pneumonia in Patients With Stroke Fed via Nasogastric Tubes Trial

“…Early after stroke, hypoxia is most frequent during transfers between wards, and within the head scanner. 25 Vomiting and regurgitation caused by motion sickness could potentially explain this finding and would suggest that vomiting and regurgitation might be more common in this patient group than hitherto appreciated.…”

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

“…Unfortunately, there are no data specific to hypoxia under GA or procedural sedation for endovascular treatment of AIS. 18,19 Patients with acute stroke may become hypoxemic because of altered central regulation of respiration, sleep apnea, weakness of the respiratory muscles, and aspiration. [20][21][22][23][24][25][26] Sleeprelated breathing disorders may be present in 44% to 95% of stroke patients 21,[27][28][29][30] and may contribute to hypoxia during pharmacologically induced sedation.…”

Hemodynamic Factors and Perfusion Abnormalities in Early Neurological Deterioration

“…Hypoxia, on the other hand, has been associated with worse clinical outcome 49 in patients with acute stroke. Treatment with normobaric oxygen has been found to improve aerobic metabolism and preserve neuronal integrity in ischemic brain tissue.…”