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Oxygen therapy in acute stroke
  1. Katherine Potier de la Morandiere, Specialist Registrar,
  2. Darren Walter, Consultant
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether supplemental oxygen reduces long term disability and mortality in patients attending the emergency department with stroke who do not require resuscitation. Altogether18 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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    Report by Katherine Potier de la Morandiere, Specialist RegistrarChecked by Darren Walter, Consultant

    Clinical scenario

    A 73 year old woman presents to the emergency department with a six hour history of left sided hemiparesis. She has a past history of hypertension. On examination she is GCS 15 with a dense left hemiparesis and her basic observations are stable. You wonder whether the use of supplemental oxygen in the acute stage is needed and will have any effect on long term prognosis.

    Three part question

    In a [patient presenting to the emergency department with a stroke who does not need resuscitative measures] is [supplemental oxygen better than no oxygen] at [reducing long term disability and mortality]?

    Search strategy

    Medline 1966-07/03 using the OVID interface. [exp cerebrovascular accident OR cerebrovacsular.mp OR stroke.mp] AND [exp oxygen OR exp oxygen inhalation therapy OR oxygen.mp] AND [exp disability evaluation OR disability.mp] LIMIT to human AND English.

    Search outcome

    Altogether 18 papers were found of which one directly addressed the three part question (table 1).

    Table 1

    Comment(s)

    This large, well conducted study shows no statistically significant difference between the two groups. It shows there is no benefit to giving oxygen routinely to stroke patients, and suggests if given to non-hypoxic patients with mild to moderate strokes may infact increase mortality. The results for severe stroke patients were inconclusive.

    The authors hypothesise (based on a small number of animal studies) that this may be attributable to oxygen free radicals.

    CLINICAL BOTTOM LINE

    In non-hypoxic patients with minor or moderate strokes supplemental oxygen is of no clinical benefit.

    Report by Katherine Potier de la Morandiere, Specialist RegistrarChecked by Darren Walter, Consultant

    References

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