Should Stroke Victims Routinely Receive Supplemental Oxygen?

Abstract

Background and Purpose-We sought to test the hypothesis that breathing 100% oxygen for the first 24 hours after an acute stroke would not reduce mortality, impairment, or disability. Methods-Subjects admitted to the Central Hospital of Akershus, Norway, with stroke onset Ͻ24 hours before admittance were allocated to 2 groups by a quasi-randomized design using birth numbers. All patients with acute stroke admitted to hospital within 24 hours after a stroke were included and enrolled. Patients were allocated to a group that received supplemental oxygen treatment (100% atmospheres, 3 L/min) for 24 hours (nϭ292) or to the control group, which did not receive additional oxygen. Main outcome measures were 1-year survival, neurological impairment (Scandinavian Stroke Scale), and disability (Barthel Index) 7 months after stroke. Results-One-year survival was 69% in the oxygen group and 73% in the control group (OR 0.82; 95% CI 0.57 to 1.19; Pϭ0.30). Impairment scores and disability scores were comparable 7 months after stroke. Among patients with Scandinavian Stroke Scale (SSS) scores of Ն40, 82% in the oxygen group and 91% in the control group survived (OR 0.45; 95% CI 0.23 to 0.90; Pϭ0.023). For patients with SSS scores of Ͻ40, 53% in the oxygen group and 48% in the control group survived (OR 1.26; 95% CI 0.76 to 2.09; Pϭ0.54). Conclusions-Supplemental oxygen should not routinely be given to nonhypoxic stroke victims with minor or moderate strokes. Further research is needed to give conclusive advice concerning oxygen supplementation for patients with severe strokes.

Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient

“…Maximization of oxygenation of all acute stroke patients has been examined in 1 quasi-randomized trial and did not show clear findings of benefit from supplemental oxygen. 87 There is general agreement, however, that hypoxic patients will benefit from supplemental oxygen. 13 Positioning of the head of the bed must be individualized for each patient.…”

Oxygen Therapy in Critical Care: A Double Edged Sword

“…Results of a great controlled trial in stroke patients found no significant difference in mortality over one year or neurological deficits among patients receiving oxygen at 3 lpm by nasal cannula for 24 hours after income and those not receiving it. Therefore, based on these data, routine supplement of oxygen in not hypoxic patients with moderate mild stroke is not recommended [36].…”

Guidelines for acute ischemic stroke treatment: part I

“…5. To adopt, in all pre-hospital transportation: monitorization of oxygen saturation, and in all who have saturation below 95% to apply oxygen supplementation; clinical evaluation of hydration and, in case of dehydration, to apply intravenous hydration with 0.9% normal saline; finger stick testing for blood glucose, and to dispense glucosecontaining fluids only in case of detected hypoglycemia (level of evidence: 1, recommendation grade: B) [39][40][41][42] ; and not to treat systemic hypertension routinely (level of evidence: 1, recommendation grade: C) 32 . 6.…”

“…It is assumed, however, that maintaining a good oxygenation is important, especially in the penumbra region, the main therapeutic target in ischemic stroke at this stage. Altered consciousness, seizure, aspiration pneumonia, heart failure and pulmonary thromboembolism are possible complications that require special ventilatory care, although the necessity of orotracheal intubation determines, frequently, a poor prognosis 39,63,64 . Dehydration in stroke patients is usually associated with a worse prognosis.…”