Dataset Information

Association between post-procedural hyperoxia and poor functional outcome after mechanical thrombectomy for ischemic stroke: an observational study.

ABSTRACT:

Background

The actual effects of oxygen therapy on patients who have suffered a stroke are still unknown, and its recommendation as a routine measure in emergency services remains controversial. The aim of this study is to determine the effect of hyperoxia in functional recovery in patients with ischemic stroke who underwent intra-arterial mechanical thrombectomy (IAMT).

Methods

A prospective observational cohort study that included all adult patients consecutively admitted to the intensive care unit (ICU) due to an ischemic stroke in the anterior cerebral circulation and following an IAMT intervention, between 2010 and 2015. All patients were intubated and connected to mechanical ventilation for the intra-arterial therapy, receiving supplementary oxygen to achieve saturations above 94%. Two groups were established regarding oxygen partial pressure (paO₂) reached. It was based on a single ICU admission blood gas analysis. The hyperoxia group was defined as paO₂?>?120 mmHg. We measured functional recovery in each of the groups according to the modified Rankin scale after 90 days.

Results

For the analysis, a total of 333 patients were included. High levels of paO₂ were mostly related to higher scores in modified Rankin scale (mRS) after 90 days. There were 60.6% cases with mRS???4 and 70.6% with mRS???3 in the hyperoxia group, compared to 43.0% and 56.1% in the paO₂???120 group, p?ConclusionsIn patients with ischemic stroke in the anterior cerebral circulation treated with IAMT, we found an association between admission PaO2?>?120 mmHg and worse functional outcome 90 days after ischemic stroke, but this association needs further confirmation by other studies.

SUBMITTER: Lopez HV

PROVIDER: S-EPMC6534627 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

Association between post-procedural hyperoxia and poor functional outcome after mechanical thrombectomy for ischemic stroke: an observational study.

López Héctor Vargas HV Vivas Miguel Fernández MF Ruiz Rafael Núñez RN Martínez José Ros JR Navaridas Blanca García-Villalba BG Villa Manuel García MG Lázaro Cristina Llamas CL Rubio Rubén Jara RJ Ortiz Ana Morales AM Lacal Laura Albert LA Diéguez Antonio Moreno AM

Annals of intensive care 20190524 1

<h4>Background</h4>The actual effects of oxygen therapy on patients who have suffered a stroke are still unknown, and its recommendation as a routine measure in emergency services remains controversial. The aim of this study is to determine the effect of hyperoxia in functional recovery in patients with ischemic stroke who underwent intra-arterial mechanical thrombectomy (IAMT).<h4>Methods</h4>A prospective observational cohort study that included all adult patients consecutively admitted to the ...[more]

PMID: 31127402

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Project description:BackgroundDysphagia is a frequent symptom in acute ischemic stroke (AIS). Endovascular treatment (EVT) has become the standard of care for acute stroke secondary to large vessel occlusion. Although standardized guidelines for poststroke dysphagia (PSD) management exist, they do not account for this setting in which patients receive EVT under general anesthesia. Therefore, the aim of this study was to evaluate PSD prevalence and severity, as well as an appropriate time point for the PSD evaluation, in patients undergoing EVT under general anesthesia (GA).MethodsWe prospectively included 54 AIS patients undergoing EVT under GA. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed within 24 h post-extubation in all patients. Patients presenting significant PSD received a second FEES-assessment to determine the course of dysphagia deficits over time. Dysphagia severity was rated according the Fiberoptic Dysphagia Severity Scale (FEDSS).ResultsAt first FEES (FEES 1) assessment, performed in the median 13 h (IQR 5-17) post-extubation, 49/54 patients (90.7%) with dysphagia were observed with a median FEDSS of 4 (IQR 3-6). Severe dysphagia requiring tube feeding was identified in 28/54 (51.9%) subjects, whereas in 21 (38.9%) patients early oral diet with certain food restrictions could be initiated. In the follow up FEES examination conducted in the median 72 h (IQR 70-97 h) after initial FEES 34/49 (69.4%) patients still presented PSD. Age (p = 0.030) and ventilation time (p = 0.035) were significantly associated with the presence of PSD at the second FEES evaluation. Significant improvement of dysphagia frequency (p = 0.006) and dysphagia severity (p = 0.001) could be detected between the first and second dysphagia assessment.ConclusionsPSD is a frequent finding both immediately within 24 h after extubation, as well as in the short-term course. In contrast to common clinical practice, to delay evaluation of swallowing for at least 24 h post-extubation, we recommend a timely assessment of swallowing function after extubation, as 50% of patients were safe to begin oral intake. Given the high amount of severe dysphagic symptoms, we strongly recommend application of instrumental swallowing diagnostics due to its higher sensitivity, when compared to clinical swallowing examination. Furthermore, advanced age, as well as prolonged intubation, were identified as significant predictors for delayed recovery of swallowing function.

Dataset Information

Association between post-procedural hyperoxia and poor functional outcome after mechanical thrombectomy for ischemic stroke: an observational study.

Background

Methods

Results

Publications

Association between post-procedural hyperoxia and poor functional outcome after mechanical thrombectomy for ischemic stroke: an observational study.

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