Hyperbaric Oxygen Therapy for Acute Ischemic Stroke
2015; Lippincott Williams & Wilkins; Volume: 46; Issue: 5 Linguagem: Inglês
10.1161/strokeaha.115.008296
ISSN1524-4628
AutoresMichael H Bennett, Stephanie Weibel, Jason Wasiak, Alexander Schnabel, Chris French, Peter Kranke,
Tópico(s)Stroke Rehabilitation and Recovery
ResumoHomeStrokeVol. 46, No. 5Hyperbaric Oxygen Therapy for Acute Ischemic Stroke Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBHyperbaric Oxygen Therapy for Acute Ischemic Stroke Michael H. Bennett, MD, Stephanie Weibel, PhD, Jason Wasiak, MPH, Alexander Schnabel, MD, Christopher French, FRACP and Peter Kranke, MD, MBA Michael H. BennettMichael H. Bennett From the Department of Diving and Hyperbaric Medicine, Faculty of Medicine, University of NSW, Sydney, Australia (M.H.B.); Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany (S.W., A.S., P.K.); Department of Radiation Oncology, The Epworth Hospital, Richmond, Australia (J.W.); and Department of Medicine (RMH), University of Melbourne, Australia (C.F.). , Stephanie WeibelStephanie Weibel From the Department of Diving and Hyperbaric Medicine, Faculty of Medicine, University of NSW, Sydney, Australia (M.H.B.); Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany (S.W., A.S., P.K.); Department of Radiation Oncology, The Epworth Hospital, Richmond, Australia (J.W.); and Department of Medicine (RMH), University of Melbourne, Australia (C.F.). , Jason WasiakJason Wasiak From the Department of Diving and Hyperbaric Medicine, Faculty of Medicine, University of NSW, Sydney, Australia (M.H.B.); Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany (S.W., A.S., P.K.); Department of Radiation Oncology, The Epworth Hospital, Richmond, Australia (J.W.); and Department of Medicine (RMH), University of Melbourne, Australia (C.F.). , Alexander SchnabelAlexander Schnabel From the Department of Diving and Hyperbaric Medicine, Faculty of Medicine, University of NSW, Sydney, Australia (M.H.B.); Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany (S.W., A.S., P.K.); Department of Radiation Oncology, The Epworth Hospital, Richmond, Australia (J.W.); and Department of Medicine (RMH), University of Melbourne, Australia (C.F.). , Christopher FrenchChristopher French From the Department of Diving and Hyperbaric Medicine, Faculty of Medicine, University of NSW, Sydney, Australia (M.H.B.); Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany (S.W., A.S., P.K.); Department of Radiation Oncology, The Epworth Hospital, Richmond, Australia (J.W.); and Department of Medicine (RMH), University of Melbourne, Australia (C.F.). and Peter KrankePeter Kranke From the Department of Diving and Hyperbaric Medicine, Faculty of Medicine, University of NSW, Sydney, Australia (M.H.B.); Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany (S.W., A.S., P.K.); Department of Radiation Oncology, The Epworth Hospital, Richmond, Australia (J.W.); and Department of Medicine (RMH), University of Melbourne, Australia (C.F.). Originally published12 Mar 2015https://doi.org/10.1161/STROKEAHA.115.008296Stroke. 2015;46:e109–e110Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2015: Previous Version 1 Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at pressures >1 atmosphere (101.3 kPa). HBOT greatly increases the partial pressure of oxygen in the blood and tissues and was first proposed in the treatment of ischemic stroke 45 years ago. The improved oxygenation may reduce cerebral edema, decrease lipid peroxidation, inhibit leukocyte activation, and restore the functional blood–brain barrier, all or some of which may promote neuronal survival.Conversely, oxygen can increase oxidative stress through the production of oxygen free-radical species, and the brain is particularly at risk. HBOT remains an experimental therapy for acute ischemic stroke.ObjectiveWe undertook a systematic review with meta-analysis to evaluate the effectiveness and safety of HBOT as an adjunctive therapy for the treatment of acute ischemic stroke.1MethodsWe performed a sensitive electronic search of multiple databases in April 2014. We included all randomized controlled trials that compared the effect of adjunctive HBOT with either no treatment or sham and in which death or functional scales were assessed as outcomes. We used standardized forms to extract the data, and each included trial was assessed for internal validity.Main ResultsEleven randomized controlled trials (705 participants) are included in the review, with 7 trials contributing to the quantitative analysis. There were no statistically significant differences in early fatality rate (3–6 months) in those receiving HBOT (relative risk 0.97, 95% CI 0.34–2.75; Figure). The statistical heterogeneity between trials was eliminated by removal of the single trial testing the combination of HBOT and a free-radical scavenger (edaravone) versus edaravone only.Download figureDownload PowerPointFigure. Mortality reported at 3 to 6 months after acute ischemic stroke.Three of the 7 trials reported improvements in a total of 4 of 19 scale measures of disability, function, or activities of daily living after HBOT. At 1 year the mean Trouillas Disability Scale was lower with HBOT (mean difference [MD] 2.2 points; 95% CI, 0.15–4.3) and the mean Orgogozo Scale was higher (MD 27.9 points; 95% CI, 4.0–51.8). These improvements were not evident in earlier assessments in the relevant trials. One trial used an undefined Neurological Functional Deficit Score and reported an early benefit from HBOT with a mean score at 3 weeks over sham (MD 3 points, 95% CI 0.4–5.6). The same trial reported the mean Barthel Index was higher at 3 weeks (MD 20 points; 95% CI 13.7–26.3).ConclusionsImplications for PracticeWe found limited clinical data, and the evidence is insufficient to confirm that HBOT significantly affects outcomes after acute ischemic stroke. Use of HBOT as routine therapy for people with stroke cannot be justified by this review.Implications for ResearchGiven the small number of participants in the trials included, we cannot be certain that a benefit from HBOT has been excluded. More information is needed on the optimal timing of therapy and subset of disease most likely to benefit. The effect of differing oxygen dosage and of other therapies administered simultaneously is not known.This article is based on a Cochrane Review published in The Cochrane Library 2014, Issue 11 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.AcknowledgmentsWe acknowledge the support and suggestions of Hazel Fraser and the editors of the Cochrane Stroke Group and thank them for their assistance in the preparation of this review. In particular, we acknowledge the help of Brenda Thomas with developing the search strategy used, and Daniel Rusyniak, Peter Langhorne, Ale Algra, and Steff Lewis for their editorial assistance.DisclosuresNone.FootnotesThe Cochrane Library is available at: http://www.thecochranelibrary.com/view/0/index.html. Reprints of the full-text version are available online from this site.Correspondence to Michael H. Bennett, MD, Prince of Wales Hospital, Barker St, Randwick, NSW 2031, Australia. E-mail [email protected]Reference1. Bennett MH, Weibel S, Wasiak J, Schnabel A, French C, Kranke P.Hyperbaric oxygen therapy for acute ischaemic stroke.Cochrane Database Syst Rev2014;(11):CD004954. doi: 10.1002/14651858.CD004954.pub3. http://dx.doi.org/10.1002/14651858.CD004954Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hussein O, Sawalha K, Elazim A, Greene-Chandos D and Torbey M (2020) Hyperbaric oxygen therapy after acute ischemic stroke with large penumbra: a case report, The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 10.1186/s41983-020-00225-9, 56:1, Online publication date: 1-Dec-2020. Segan L, Permezel F, Ch'ng W, Millar I, Brooks M, Lee-Archer M and Cloud G (2017) Cerebral arterial gas embolism from attempted mechanical thrombectomy: recovery following hyperbaric oxygen therapy, Practical Neurology, 10.1136/practneurol-2017-001828, 18:2, (134-136), Online publication date: 1-Apr-2018. Cai L, Stevenson J, Geng X, Peng C, Ji X, Xin R, Rastogi R, Sy C, Rafols J and Ding Y (2016) Combining Normobaric Oxygen with Ethanol or Hypothermia Prevents Brain Damage from Thromboembolic Stroke via PKC-Akt-NOX Modulation, Molecular Neurobiology, 10.1007/s12035-016-9695-7, 54:2, (1263-1277), Online publication date: 1-Mar-2017. Cai L, Stevenson J, Peng C, Xin R, Rastogi R, Liu K, Geng X, Gao Z, Ji X, Rafols J, Ji Z and Ding Y (2016) Adjuvant therapies using normobaric oxygen with hypothermia or ethanol for reducing hyperglycolysis in thromboembolic cerebral ischemia, Neuroscience, 10.1016/j.neuroscience.2016.01.010, 318, (45-57), Online publication date: 1-Mar-2016. Sri Dewi Untari N, Kusumastuti K, Suryokusumo G and Sudiana I (2021) Characteristics of Guillain-Barre Syndrome Patient Underwent Hyperbaric Oxygen Therapy at Lakesla 2016–2019, Open Access Macedonian Journal of Medical Sciences, 10.3889/oamjms.2021.6679, 9:B, (1174-1179) May 2015Vol 46, Issue 5 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.115.008296 Manuscript receivedJanuary 8, 2015Manuscript acceptedFebruary 18, 2015Originally publishedMarch 12, 2015Manuscript revisedFebruary 16, 2015 Keywordsbrain infarctionhyperbaric oxygenationmeta-analysisPDF download Advertisement SubjectsCardiopulmonary Resuscitation and Emergency Cardiac CareCerebrovascular Disease/StrokeIschemic StrokeTreatment
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