The effect of normobaric oxygen in patients with acute stroke: a systematic review and meta-analysis

Ding, Jiayue; Zhou, Da; Meng, Shu; Wang, Mengqi; Chandra, Ankush; Han, Jia; Ding, Yuchuan; Ji, Xunming

doi:10.1080/01616412.2018.1454091

Cited by 29 publications

(30 citation statements)

References 42 publications

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“…Additionally, normobaric oxygen can slow the progression of cell death, extend the time window for revascularization therapy, and salvage ischemic brain tissue. [59,60] Preliminary safety, feasibility, and efficacy of this strategy have been demonstrated in a recent clinical trial. [61] In clinical practice, many patients first arrive at primary hospitals that are not capable of thrombectomy or intravenous thrombolysis and are subsequently transferred to a comprehensive stroke center for reperfusion therapies.…”

Section: Before Revascularizationmentioning

confidence: 99%

Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes

Zhao

Dornbos

et al. 2020

Brain Circ

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While several large pivotal clinical trials recently revealed a substantial benefit of endovascular thrombectomy for acute ischemic stroke (AIS) caused by large-vessel occlusion, many patients still experience mediocre prognosis. Enlargement of the ischemic core, failed revascularization, incomplete reperfusion, distal embolization, and secondary reperfusion injury substantially impact the salvaging of brain tissue and the functional outcomes of AIS. Here, we propose novel concept of "Multiphase Adjuvant Neuroprotection" as a new paradigm that may help guide our search for adjunctive treatments to be used together with thrombectomy. The premise of multiphase adjuvant neuroprotection is based on the diverse and potentially nonoverlapping pathophysiologic mechanisms that are triggered before, during, and after thrombectomy therapies. Before thrombectomy, strategies should focus on preventing the growth of the ischemic core; during thrombectomy, improving recanalization while reducing distal embolization and maximizing reperfusion are of significant importance; after reperfusion, strategies should focus on seeking targets to reduce secondary reperfusion injury. The concept of multiphase adjuvant neuroprotection, wherein different strategies are employed throughout the various phases of clinical care, might provide a paradigm to minimize the final infarct size and improve functional outcome in AIS patients treated with thrombectomy. With the success of thrombectomy in selected AIS patients, there is now an opportunity to revisit stroke neuroprotection. Notably, if the underlying mechanisms of these neuroprotective strategies are identified, their role in the distinct phases will provide further avenues to improve patient outcomes of AIS.

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Section: Before Revascularizationmentioning

confidence: 99%

Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes

Zhao

Dornbos

et al. 2020

Brain Circ

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“…26,27 Studies from the stroke setting demonstrated no benefit of liberal O 2 therapy in those patients. 30 A study in the critical care setting reported an absolute risk reduction of 8.6% for the primary outcome of intensive care unit mortality with conservative O 2 therapy (PaO 2 = 70-100 mmHg or SpO 2 = 94-98%) as compared with usual care (FiO 2 ≥ 0.40, PaO 2 = 100-150 mmHg, and SpO 2 ≥ 97%). 30 A study in the critical care setting reported an absolute risk reduction of 8.6% for the primary outcome of intensive care unit mortality with conservative O 2 therapy (PaO 2 = 70-100 mmHg or SpO 2 = 94-98%) as compared with usual care (FiO 2 ≥ 0.40, PaO 2 = 100-150 mmHg, and SpO 2 ≥ 97%).…”

Section: Discussionmentioning

confidence: 99%

“…28,29 A total of 11 RCTs including 6366 patients with acute stroke showed a non-significant increase in mortality at 3, 6, and 12 months with normobaric O 2 as compared with room air. 30 A study in the critical care setting reported an absolute risk reduction of 8.6% for the primary outcome of intensive care unit mortality with conservative O 2 therapy (PaO 2 = 70-100 mmHg or SpO 2 = 94-98%) as compared with usual care (FiO 2 ≥ 0.40, PaO 2 = 100-150 mmHg, and SpO 2 ≥ 97%). 31 A multi-centre RCT in patients with stable COPD and moderate desaturation at rest or during exercise showed no benefit of long-term supplemental O 2 therapy in terms of time to death or hospitalization.…”

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confidence: 99%

High vs. low oxygen therapy in patients with acute heart failure: HiLo‐HF pilot trial

et al. 2019

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Aims Most patients with acute heart failure (AHF) are treated with supplemental oxygen during hospitalization. In this study, we investigated the effect of oxygen titrated to high vs. low pulse oximetry targets in patients hospitalized with AHF. Methods and results In a pilot, open‐label randomized controlled trial (RCT), 50 patients who were admitted with AHF were randomized to either high (≥96%) or low (90–92%) SpO2 targets. Oxygen was manually titrated to the assigned target ranges for 72 h. The primary endpoint was the change in N‐terminal pro‐brain‐type natriuretic peptide (NT‐proBNP) from randomization to 72 h, and secondary endpoints included patient‐reported dyspnoea by visual analogue scale (VAS), patient global assessment (PGA), peak expiratory flow (PEF) within 72 h, and clinical outcomes up to 30 days following hospital discharge. The median age was 73.5 years, and 42% were women. The change in NT‐proBNP was −6963 (−13 345, −1253) pg/mL in the high SpO2 group and −2093 (−5692, −353) pg/mL in the low SpO2 group (P = 0.46), and the 72 h to baseline NT‐proBNP ratio was similar between groups (0.7 vs. 0.6, P = 0.51). There were no differences between arms in change in dyspnoea VAS (P = 0.86), PGA (P = 0.91), PEF (P = 0.52), in‐hospital mortality (4.0% vs. 8.0%, P = 0.50), or 30 day heart failure readmission rates (20.8% vs. 8.7%, P = 0.22). Conclusions In this study, no differences were observed in the primary or secondary outcomes for patients randomized to high vs. low SpO2 targets. Further RCTs with larger sample sizes are warranted to determine the efficacy and safety of oxygen therapy in patients with AHF.

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“…A meta-analysis showed a minor trend toward benefits with oxygen therapy in patients with stroke. However, controversy persists since various results have been obtained in different studies such as an improvement of the short-term neurological score and a worsening of both the physical function and mortality after more than 3 months [ 94 ].…”

Section: Clinical Implications Of Oxidative Stressmentioning

confidence: 99%

Biological effects of the oxygen molecule in critically ill patients

Nakane

2020

j intensive care

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The medical use of oxygen has been widely and frequently proposed for patients, especially those under critical care; however, its benefit and drawbacks remain controversial for certain conditions. The induction of oxygen therapy is commonly considered for either treating or preventing hypoxia. Therefore, the concept of different types of hypoxia should be understood, particularly in terms of their mechanism, as the effect of oxygen therapy principally varies by the physiological characteristics of hypoxia. Oxygen molecules must be constantly delivered to all cells throughout the human body and utilized effectively in the process of mitochondrial oxidative phosphorylation, which is necessary for generating energy through the formation of adenosine triphosphate. If the oxygen availability at the cellular level is inadequate for sustaining the metabolism, the condition of hypoxia which is characterized as heterogeneity in tissue oxygen tension may develop, which is called dysoxia, a more physiological concept that is related to hypoxia. In such hypoxic patients, repetitive measurements of the lactate level in blood are generally recommended in order to select the adequate therapeutic strategy targeting a reduction in lactate production. Excessive oxygen, however, may actually induce a hyperoxic condition which thus can lead to harmful oxidative stress by increasing the production of reactive oxygen species, possibly resulting in cellular dysfunction or death. In contrast, the human body has several oxygen-sensing mechanisms for preventing both hypoxia and hyperoxia that are employed to ensure a proper balance between the oxygen supply and demand and prevent organs and cells from suffering hyperoxia-induced oxidative stress. Thus, while the concept of hyperoxia is known to have possible adverse effects on the lung, the heart, the brain, or other organs in various pathological conditions of critically ill patients, and no obvious evidence has yet been proposed to totally support liberal oxygen supplementation in any subset of critically ill patients, relatively conservative oxygen therapy with cautious monitoring appears to be safe and may improve the outcome by preventing harmful oxidative stress resulting from excessive oxygen administration. Given the biological effects of oxygen molecules, although the optimal target levels remain controversial, unnecessary oxygen administration should be avoided, and exposure to hyperoxemia should be minimized in critically ill patients.

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The effect of normobaric oxygen in patients with acute stroke: a systematic review and meta-analysis

Cited by 29 publications

References 42 publications

Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes

Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes

High vs. low oxygen therapy in patients with acute heart failure: HiLo‐HF pilot trial

Biological effects of the oxygen molecule in critically ill patients

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