What is the safety and efficacy supplemental oxygen therapy versus treatment as usual in patient with acute stroke?

ReferenceStudy type Evidence levelNumber of patientsPatient characteristicsInterventionComparisonLength of follow-upOutcome measuresSource of funding
Ronning OM, Guldvog B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke. 1999; 30(10):2033–2037. Ref ID: 2555

Breathing 100% oxygen for the first 24 hrs after an acute stroke
Quasi-randomised control trial, single centre Norway 1+N=550Patients with acute stroke referred within 24 hrs of a stroke

Exclusion criteria: age < 60 yrs

Patient population: mean age 74.6 yrs and 53% male, 12.7% haemorrhagic stroke

The groups were well matched at baseline
Supplemented oxygen treatment
(100% atmospheres, 3 L/min)

N=229

33 patients did not receive supplemented oxygen as described (not given such treatment or were treated for less than 24 hrs)
No oxygen treatment

N=258

66 patients were given oxygen but for a lot less than 24 hrs
One yearMorality DependencyNone reported
Effect
* Mortality and dependency
At one year follow-up, there were no statistical differences between patients with oxygen therapy compared with control patients in terms of mortality, Scandinavian Stroke and Barthel Index

*Stroke severity
The one year survival rate was higher in the control group than patients with moderate or mild strokes (SSS score ≥ 40 on admission) (90.7% vs 81.8%; OR 0.45; 95%CI 0.23 to 0.90; p=0.023) but not when compared with severe stroke (SSS score < 40 on admission) (NS). There were no other statistical differences between the levels of stroke severity on measures of mortality or dependency when compared with controls.

*Summary
No evidence that oxygen therapy given as a routine treatment is of benefit to stroke patients. It may increase mortality in patients with mild to moderate stroke
Chiu EH, Liu CS, Tan TY et al. Venturi mask adjuvant oxygen therapy in severe acute ischemic stroke. Archives of Neurology. 2006; 63(5):741–744. Ref ID: 6

To investigate the feasibility of hpperoxia therapy by Venturi mask (VM) in a group of patients who experienced a severe acute ischemic stroke
Prospective cohort, single site, china 2−N=46Patients with first-ever ischemic stroke admitted within 48 hrs of stroke onset

Inclusion criteria: infarction in the middle cerebral artery (MCA) territory, NIHSS of 12, mRS of not less than 4 and CT evidence that the infarction was more than one third of the MCA territory

Exclusion criteria included rapidly improving neurological deficits, receiving antithrombotic therapy within last three months

Patient population: mean age 79 yrs, 30% male, BP (systolic) 167 mm HG (diastolic) 95 mm HG

There were no statistical differences at baseline
Supplemented oxygen therapy by Venturi mask with a fraction of inspired oxygen of 40%

N=17

VM therapy was initiated within 13.7 hrs after stroke onset. The duration of VM use was 132.9 hrs
Nasal cannula 2 L/min

N=29
Until dischargeMortality Pneumonia Length of hospital stayNone reported
Effect
*Mortality
There were no statistical differences between VM and NC patients on mortality (NS)

* Pneumonia
There were no statistical differences between VM and NC patients in the number of episodes of pneumonia

* Length of stay
There were no statistical differences between VM and NC patients on the length of stay

From: Evidence Tables

Cover of Stroke
Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA).
NICE Clinical Guidelines, No. 68.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2008, Royal College of Physicians of London.

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