The S troke O xygen S upplementation PILOT Study. C. Roffe, K. Ali, A. Warusevitane, S. Sills, S. Pountain, P Jones, R Gray, P. Crome North Staffordshire Combined Healthcare Trust University Hospital of North Staffordshire Brighton and Sussex University Hospital
C. Roffe, K.Ali, A. Warusevitane, S. Sills, S. Pountain, P Jones, R Gray, P. Crome
North Staffordshire Combined Healthcare Trust
University Hospital of North Staffordshire
Brighton and Sussex University Hospital
University Hospital Birmingham
The North Staffordshire
Incidence of hypoxia
63% in the first 2 days
Sulter et al, J Neurol Sci 2000;179:65-9.
Roffe et al, Stroke 2003;34:2641-2645.
381 consecutive patients with acute stroke
Oxygen saturation <90 doubles risk of early deterioration.
Silva et al, Cerebrovasc Dis 2001;11(suppl 4):70
Rowat et al. Cerebrovasc Dis 2006;21:166-172.
Time spent with an oxygen saturation <90% at night
52% more than 5 minutes
23% more than 30 minutes
15% more than 1 hour
Roffe et al, Stroke 2003;34:2641-2645
Shin, H. K. et al. Brain 2007 130:1631-1642
Liu et al J Cereb Blood Flow Metab. 2006;26:1274-84.
Mild strokes SSS>40 (top)
Severe strokes SSS £ 40 (bottom)
Ronning and Guldvog, Stroke 1999;30:2033-37.
Singhal et al . Stroke. 2005;36:797-802.
UK National Clinical Guidelines for Stroke
Arterial oxygen concentration should be maintained within normal limits 2004
Give Oxygen to maintain oxygen saturation at or above 95% 2008
European Stroke Initiative Recommendations for Stroke Management
2-4L/min when indicated in 2003
Oxygen if saturation<92% in 2007
American Stroke Association Guidelines
Oxygen if saturation <95% in 2003 and 2005
Oxygen if saturation </=92% in 2007
National Clinical Guidelines for Stroke. RCP 2004, 2008, NICE 2008, EUSI 2004, ESO 2007; ASA, Stroke. 2003;34(4):1056-83, 2005;36:916-23, 2007;38:1655-1711.
Routine oxygen supplementation during the first three days after an acute stroke
Prospective randomized open study
SpO2: oxygen saturation a Time corrected to a standard 8 hour night *p<0.05, **p<0.01, ***p<0.01
NIHSS: National Institute for Health Stroke Scale; ***p<0.001
mRS modified Rankin Scale;
This pilot study demonstrates
This pilot study was not powered to look at neurological or functional outcomes or to do subgroup analyses
Results so far are that routine oxygen supplementation
A larger study is required to determine whether routine oxygen supplementation is effective in reducing neurological deficit and improving functional outcome