Hyperbaric Oxygen in Acute Ischemic Stroke
2003; Lippincott Williams & Wilkins; Volume: 34; Issue: 9 Linguagem: Inglês
10.1161/01.str.0000087099.36383.60
ISSN1524-4628
Autores Tópico(s)Stroke Rehabilitation and Recovery
ResumoHomeStrokeVol. 34, No. 9Hyperbaric Oxygen in Acute Ischemic Stroke Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBHyperbaric Oxygen in Acute Ischemic Stroke K.K. Jain K.K. JainK.K. Jain PharmaBiotech, Basel, Switzerland Originally published21 Aug 2003https://doi.org/10.1161/01.STR.0000087099.36383.60Stroke. 2003;34:e153Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: August 21, 2003: Previous Version 1 To the Editor:Dr Rusyniak et al1 have recently presented the results of a clinical trial of hyperbaric oxygen (HBO) in acute ischemic stroke. The authors are aware of previous human studies in stroke patients indicating that 100% oxygen at pressure of 1.5 atm absolute (ATA) is better tolerated than higher pressures by the brain injured by acute ischemia. Safety of HBO is not an issue here, as pressure of 2.5 ATA is used safely for other indications. The authors mention that 400 stroke patients have been treated with HBO in previously reported studies. This number exceeds 2000 and references to these studies are easily available in a standard text on this subject.2 The majority of these patients were treated by HBO pressures under 2 ATA. I do not understand why the authors chose to ignore this experience and decided to follow the results of animal studies, some of which have been conducted at higher pressures but no correlation has been established between pressure and efficacy of HBO treatment in these studies. I am not surprised that the patients who received oxygen at 1.14 ATA did better than those who received it at 2.5 ATA because the former is closer to the ideal pressure of 1.5 ATA.My other criticism of the study is that it was not restricted to patients in the first 3 hours following stroke or even the first 6 hours. There are logistic problems in applying HBO treatments in a time window that overlaps with thrombolytic therapy. Potential solutions to these problems were discussed in a conference more than 5 years ago and the proceedings were published.3 Since HBO is used as a neuroprotective, it can be combined with thrombolytic therapy, which is directed at the cause. Clinical trials of combination of HBO and thrombolytic therapy are being conducted.I believe that the study did not serve any useful purpose or contribute to knowledge of stroke or HBO beyond what is already known. With negative results, the authors have closed the door to further trials on this topic. It would have been better if they had had another group of patients treated at 1.5 ATA so that the results could be compared with those treated at 2.5 ATA.1 Rusyniak DE, Kirk MA, May JD, Kao LW, Brizendine EJ, Welch JL, Cordell WH, Alonso RJ. Hyperbaric oxygen therapy in acute ischemic stroke: results of the Hyperbaric Oxygen in Acute Ischemic Stroke Trial Pilot Study. Stroke. 2003; 34: 571–574.LinkGoogle Scholar2 Jain KK. Role of hyperbaric oxygenation in the management of stroke. In: Jain KK, ed. Textbook of Hyperbaric Medicine. 3rd ed. Göttingen, Germany: Hogrefe & Huber; 1999:282–317. 4th ed; 2003. In press.Google Scholar3 Jain KK, Toole JF, eds. Hyperacute hyperbaric oxygen therapy for stroke: proceedings of a conference. Undersea & Hyperbaric Medical Society of the USA. Bethesda, Maryland; 1998.Google Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Krishnamurti C (2020) Historical Aspects of Hyperbaric Physiology and Medicine Respiratory Physiology, 10.5772/intechopen.85216 Mijajlovic M, Aleksic V, Milosevic N and Bornstein N (2020) Hyperbaric oxygen therapy in acute stroke: is it time for Justitia to open her eyes?, Neurological Sciences, 10.1007/s10072-020-04241-8, 41:6, (1381-1390), Online publication date: 1-Jun-2020. Jain K (2017) Role of Hyperbaric Oxygenation in the Management of Stroke Textbook of Hyperbaric Medicine, 10.1007/978-3-319-47140-2_19, (237-268), . Wang Q and Xiong L (2013) HBO Preconditioning for TBI and Stroke Patients Innate Tolerance in the CNS, 10.1007/978-1-4419-9695-4_28, (579-589), . Michalski D, Härtig W, Schneider D and Hobohm C (2011) Use of normobaric and hyperbaric oxygen in acute focal cerebral ischemia - a preclinical and clinical review, Acta Neurologica Scandinavica, 10.1111/j.1600-0404.2010.01363.x, 123:2, (85-97), Online publication date: 1-Feb-2011. Rink C, Roy S, Khan M, Ananth P, Kuppusamy P, Sen C and Khanna S (2010) Oxygen-Sensitive Outcomes and Gene Expression in Acute Ischemic Stroke, Journal of Cerebral Blood Flow & Metabolism, 10.1038/jcbfm.2010.7, 30:7, (1275-1287), Online publication date: 1-Jul-2010. Michalski D, Küppers-Tiedt L, Weise C, Laignel F, Härtig W, Raviolo M, Schneider D and Hobohm C (2009) Long-term functional and neurological outcome after simultaneous treatment with tissue-plasminogen activator and hyperbaric oxygen in early phase of embolic stroke in rats, Brain Research, 10.1016/j.brainres.2009.09.038, 1303, (161-168), Online publication date: 1-Nov-2009. Singhal A (2013) A review of oxygen therapy in ischemic stroke, Neurological Research, 10.1179/016164107X181815, 29:2, (173-183), Online publication date: 1-Mar-2007. Singhal A (2016) Oxygen Therapy in Stroke: Past, Present, and Future, International Journal of Stroke, 10.1111/j.1747-4949.2006.00058.x, 1:4, (191-200), Online publication date: 1-Nov-2006. Liebeskind D (2014) Collateral therapeutics for cerebral ischemia, Expert Review of Neurotherapeutics, 10.1586/14737175.4.2.255, 4:2, (255-265), Online publication date: 1-Mar-2004. September 2003Vol 34, Issue 9 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000087099.36383.60PMID: 12933966 Originally publishedAugust 21, 2003 PDF download Advertisement
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