Effects of Repetitive Hyperbaric Oxygen Treatment in Patients with Acute Cerebral Infarction: A Pilot Study

The Scientific World Journal, Aug 2012

The role of hyperbaric oxygen therapy (HBOT) in the treatment of acute ischemic stroke is controversial. This prospective study assessed the efficacy and safety of HBOT as adjuvant treatment on 46 acute ischemic stroke in patients who did not receive thrombolytic therapy. The HBOT group (?=16) received conventional medical treatment with 10 sessions of adjunctive HBOT within 3–5 days after stroke onset, while the control group (?=30) received the same treatment but without HBOT. Early (around two weeks after onset) and late (one month after onset) outcomes (National Institutes of Health Stroke Scale, NIHSS scores) and efficacy (changes of NIHSS scores) of HBOT were evaluated. The baseline clinical characteristics were similar in both groups. Both early and late outcomes of the HBOT group showed significant difference (?≤0.001). In the control group, there was only significant difference in early outcome (?=0.004). For early efficacy, there was no difference when comparing changes of NIHSS scores between the two groups (?=0.140) but there was statistically significant difference when comparing changes of NIHSS scores at one month (?≤0.001). The HBOT used in this study may be effective for patients with acute ischemic stroke and is a safe and harmless adjunctive treatment.

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Effects of Repetitive Hyperbaric Oxygen Treatment in Patients with Acute Cerebral Infarction: A Pilot Study

Effects of Repetitive Hyperbaric Oxygen Treatment in Patients with Acute Cerebral Infarction: A Pilot Study Cheng-Hsin Chen,1 Shao-Yuan Chen,2,3,4,5 Vinchi Wang,2,4,5 Chao-Ching Chen,2,5 Kaw-Chen Wang,2 Chih-Hao Chen,2 Yi-Chien Liu,2 Kuo-Cheng Lu,1,5 Ping-Keung Yip,2,5 Wen-Ya Ma,1,5 and Chuan-Chieh Liu1,5 1Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan 2Department of Neurology, Cardinal Tein Hospital, New Taipei City, Taiwan 3Department of Hyperbaric Medicine, Cardinal Tein Hospital, New Taipei City, Taiwan 4Department of Medical Research, Cardinal Tien Hospital, New Taipei City, Taiwan 5School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan Received 3 April 2012; Accepted 21 May 2012 Academic Editors: G. Cheron and R. Kirchmair Copyright © 2012 Cheng-Hsin Chen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The role of hyperbaric oxygen therapy (HBOT) in the treatment of acute ischemic stroke is controversial. This prospective study assessed the efficacy and safety of HBOT as adjuvant treatment on 46 acute ischemic stroke in patients who did not receive thrombolytic therapy. The HBOT group () received conventional medical treatment with 10 sessions of adjunctive HBOT within 3–5 days after stroke onset, while the control group () received the same treatment but without HBOT. Early (around two weeks after onset) and late (one month after onset) outcomes (National Institutes of Health Stroke Scale, NIHSS scores) and efficacy (changes of NIHSS scores) of HBOT were evaluated. The baseline clinical characteristics were similar in both groups. Both early and late outcomes of the HBOT group showed significant difference (). In the control group, there was only significant difference in early outcome (). For early efficacy, there was no difference when comparing changes of NIHSS scores between the two groups () but there was statistically significant difference when comparing changes of NIHSS scores at one month (). The HBOT used in this study may be effective for patients with acute ischemic stroke and is a safe and harmless adjunctive treatment. 1. Introduction In most developed countries, cerebrovascular disease is always ranked in the top ten causes of death. In Taiwan, about 70% of hospitalized acute stroke patients have ischemic stroke. Although the mortality rate of acute ischemic stroke is less than that of hemorrhagic stroke, it still results in patient disabilities and complications that often lead to significant costs to individuals, families, and society. Traditional treatment for acute ischemic stroke includes thrombolytic therapy by injecting t-PA within three hours after onset of symptoms, and antiplatelet and/or anticoagulant agents administered within the first 48 hours. Clinically, the narrow time window of thrombolytic therapy and coexisting contraindications limit the use of t-PA [1, 2]. Thus, searching for an effective supplemental treatment for acute ischemic stroke is imperative. Hyperbaric oxygen therapy (HBOT) is valuable in treating acute CO poisoning, air or gas embolism [3, 4] and in facilitating wound healing [5]. Known mechanisms of HBOT-induced neuroprotection include enhancing neuronal viability via increased tissue oxygen delivery to the area of diminished blood flow, reducing brain edema, and improving metabolism after ischemia [6, 7]. Furthermore, a recent study performed on a rat suggested that upregulation of the expression of glial derived neurotrophic factor (GDNF) and nerve growth factor (NGF) might underlie the effect of HBOT [8]. Despite beneficial results in several animal models [9, 10], the effectiveness in human ischemic stroke is still controversial. In a randomized, prospective, double-blind, and sham-controlled pilot study published in 2003, Rusyniak et al. delivered HBOT to 33 patients with acute ischemic stroke who did not receive thrombolytic therapy, and assessed the therapeutic effectiveness after 24 hours and 90 days. They concluded that HBOT did not appear to be beneficial and might even be harmful for patients with acute ischemic stroke [11]. However, the viewpoint and shortcomings of this trial were challenged by others who suggested that further studies were needed to determine the feasibility of lower pressures, greater numbers of dives with better clinical outcomes, and suitable stroke subtype. In 2006, Bennett et al. included three randomized controlled trials (106 participants) to assess the benefits and safety of adjunctive HBOT in the treatment of acute ischemic stroke. Their systematic review did not demonstrate that HBOT could improve clinical outcomes. However, due to the lack of guidelines for study design, the use of HBOT in stroke patients could not be justified [12]. Moreover, a previous report showed (...truncated)


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Cheng-Hsin Chen, Shao-Yuan Chen, Vinchi Wang, Chao-Ching Chen, Kaw-Chen Wang, Chih-Hao Chen, Yi-Chien Liu, Kuo-Cheng Lu, Ping-Keung Yip, Wen-Ya Ma, Chuan-Chieh Liu. Effects of Repetitive Hyperbaric Oxygen Treatment in Patients with Acute Cerebral Infarction: A Pilot Study, The Scientific World Journal, 2012, 2012, DOI: 10.1100/2012/694703