RESUMEN
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Asunto(s)
COVID-19/epidemiología , Prestación Integrada de Atención de Salud/métodos , Pandemias , Accidente Cerebrovascular/epidemiología , Telemedicina/métodos , Anciano , Anciano de 80 o más Años , COVID-19/terapia , Prestación Integrada de Atención de Salud/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , New England/epidemiología , Estudios Retrospectivos , Accidente Cerebrovascular/terapia , Telemedicina/tendenciasRESUMEN
Neuroprotective drugs have so far failed clinical trials, at high cost, and intravenous tissue plasminogen activator (i.v. tPA) remains the only FDA-approved acute stroke therapy. Hyperoxia, acting via multiple direct and indirect mechanisms, may be a powerful neuroprotective strategy to salvage acutely ischemic brain tissue and extend the time window for acute stroke treatment. Of the available oxygen delivery methods, hyperbaric oxygen therapy (HBO) appears to be the most potent, while even normobaric oxygen therapy (NBO) may be effective if started promptly after stroke onset. HBO has so far failed to show efficacy in three clinical trials. The failure of these trials is probably attributable to factors such as delayed time to therapy, inadequate sample size and use of excessive chamber pressures. Previous trials did not assess long-term benefit in patients with tissue reperfusion. In this modern era of stroke thrombolysis and advanced neuroimaging, oxygen therapy may have renewed significance. If applied within the first few hours after stroke onset or in patients with imaging evidence of salvageable brain tissue, oxygen therapy could be used to 'buy time' for the administration of thrombolytic or neuroprotective drugs. This article reviews the history and current rationale for using oxygen therapy in stroke, the mechanisms of action of HBO and the results of animal and human studies of hyperoxia in cerebrovascular diseases.
Asunto(s)
Isquemia Encefálica/fisiopatología , Isquemia Encefálica/terapia , Oxigenoterapia Hiperbárica/normas , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Animales , Encéfalo/irrigación sanguínea , Encéfalo/metabolismo , Encéfalo/fisiopatología , Circulación Cerebrovascular/fisiología , Ensayos Clínicos como Asunto/estadística & datos numéricos , Metabolismo Energético/fisiología , Humanos , Oxigenoterapia Hiperbárica/efectos adversos , Oxigenoterapia Hiperbárica/tendencias , Modelos Animales , Resultado del TratamientoRESUMEN
Oxygen is frequently administered to patients with suspected stroke. However, the role of oxygen therapy in ischemic stroke remains controversial in light of the failure of three clinical trials of hyperbaric oxygen therapy to show efficacy, and the fear of exacerbating oxygen free radical injury. The previous trials had several shortcomings, perhaps because they were designed on basis of anecdotal case reports and little preclinical data. Most animal studies concerning oxygen therapy in stroke have been conducted over the last 6 years. Emerging data suggests that hyperbaric and even normobaric oxygen therapy can be effective if used appropriately, and raises the tantalizing possibility that hyperoxia can be used to extend the narrow therapeutic time window for stroke thrombolysis. This article reviews the history, rationale, mechanisms of action and adverse effects of hyperoxia, the key results of previous hyperoxia studies, and the potential role of oxygen therapy in contemporary stroke treatment.