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The potential long-term neurological improvement of early hyperbaric oxygen therapy on hemorrhagic stroke in the diabetics

Published:February 03, 2018DOI:https://doi.org/10.1016/j.diabres.2018.01.017

      Highlights

      • Hyperbaric oxygen therapy (HBOT) was used as a therapy improving outcome following brain injury.
      • HBOT resulted into higher percentage of good outcome in intracerebral hemorrhage patients.
      • HBOT was feasible and safe as adjuvant therapy in diabetes patients with intracerebral hemorrhage.

      Abstract

      Aims

      Although Hyperbaric oxygen therapy (HyperBOT) attract our attention successfully these days, it is still full of controversy on the treatment of acute stroke. The aim of this study is to assess the potential long-term neurological consequences and safety of using HyperBOT on intracerebral hemorrhage (ICH) in the diabetics.

      Methods

      In this prospective, randomized controlled trial, 79 diabetes patients suffering from acute ICH were randomized to treat for 60 min in a monoplace hyperbaric chamber pressurized with pure oxygen to 2.5-atm absolute (ATA) in the HyperBOT group or 1.5 ATA in the normobaric oxygen therapy (NormBOT) group, which was performed as control. Both short-term and long-term neurological consequences were studied and compared in each group on National Institutes of Health Stroke Scale [NIHSS], Barthel Index, modified Rankin Scale [mRS] and Glasgow Outcome Scale [GOS]. The related complications or side-events of all patients were recorded as well at the final follow-up of six months after onset.

      Results

      No distinct difference was observed between each group at one month follow-up. However, in the long-term follow-up of six months, a higher frequency of patients in the HyperBOT group resulted into good outcome with a relative high neurological consequence compared with the NormBOT group (Barthel Index: 85.1% versus 65.6%, P = 0.080; mRS: 89.4% versus 68.8%, P = 0.045; GOS: 83.0% versus 62.5%, P = 0.073; NIHSS: 80.9% versus 56.2%, P = 0.035).

      Conclusions

      Early HyperBOT was found to be safe and effective with regards to the long-term neurological outcome of diabetic patients suffering from ICH.

      Keywords

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      References

        • Noor Hassim I.
        • Norazman M.R.
        • Diana M.
        • Khairul Hazdi Y.
        • Rosnah I.
        Cardiovascular risk assessment between urban and rural population in Malaysia.
        Med J Malaysia. 2016; 71: 331-337
        • Nakayama H.
        • Nishida K.
        • Otsu K.
        Macromolecular degradation systems and cardiovascular aging.
        Circ Res. 2016; 118: 1577-1592
        • Mink R.B.
        • Dutka A.J.
        Hyperbaric oxygen after global cerebral ischemia in rabbits does not promote brain lipid peroxidation.
        Crit Care Med. 1995; 23: 1398-1404
        • Thom S.R.
        Functional inhibition of leukocyte B2 integrins by hyperbaricoxygen in carbon monoxide-mediated brain injury in rats.
        Toxicol Appl Pharmacol. 1993; 123: 248-256
        • Mink R.B.
        • Dutka A.J.
        Hyperbaric oxygen after global cerebral ischemia in rabbits reduces brain vascular permeability and blood flow.
        Stroke. 1995; 26: 2307-2312
        • Jokinen-Gordon H.
        • Barry R.C.
        • Watson B.
        • Covington D.S.
        A retrospective analysis of adverse events in hyperbaric oxygen therapy (2012–2015): lessons learned from 1.5 million treatments.
        Adv Skin Wound Care. 2017; 30: 125-129
        • van Ophoven A.
        • Rossbach G.
        • Pajonk F.
        • Hertle L.
        Safety and efficacy of hyperbaric oxygen therapy for the treatment of interstitial cystitis: a randomized, sham controlled, double-blind trial.
        J Urol. 2006; 176: 1442-1446
        • Zhao D.
        • Luo S.
        • Xu W.
        • Hu J.
        • Lin S.
        • Wang N.
        Efficacy and safety of hyperbaric oxygen therapy used in patients with diabetic foot: a meta-analysis of randomized clinical trials.
        Clin Ther. 2017; 39: 2088-2094.e2
        • Soejima Y.
        • Hu Q.
        • Krafft P.R.
        • Fujii M.
        • Tang J.
        • Zhang J.H.
        Hyperbaric oxygen preconditioning attenuates hyperglycemia-enhanced hemorrhagic transformation by inhibiting matrix metalloproteinases in focal cerebral ischemia in rats.
        Exp Neurol. 2013; 247: 737-743
        • Bian H.
        • Hu Q.
        • Liang X.
        • Chen D.
        • Li B.
        • Tang J.
        • et al.
        Hyperbaric oxygen preconditioning attenuates hemorrhagic transformation through increasing PPARγ in hyperglycemic MCAO rats.
        Exp Neurol. 2015; 265: 22-29
        • Qin Z.
        • Karabiyikoglu M.
        • Hua Y.
        • Silbergleit R.
        • He Y.
        • Keep R.F.
        • et al.
        Hyperbaric oxygen-induced attenuation of hemorrhagic transformation after experimental focal transient cerebral ischemia.
        Stroke. 2007; 38: 1362-1367
        • Neubauer R.A.
        • End E.
        Hyperbaric oxygenation as an adjunct therapy in strokes due to thrombosis: a review of 122 patients.
        Stroke. 1980; 11: 297-300
        • Liu J.T.
        • Lee J.K.
        • Tyan Y.S.
        • Liu C.Y.
        • Chen Y.H.
        • Lin T.B.
        Neuromodulation on cervical spinal cord combined with hyperbaric oxygen in comatose patients–a preliminary report.
        Surg Neurol. 2009; 72: S28-34
        • Al-Waili N.S.
        • Butler G.J.
        • Beale J.
        • Abdullah M.S.
        • Hamilton R.W.
        • Lee B.Y.
        • et al.
        Hyperbaric oxygen in the treatment of patients with cerebral stroke, brain trauma, and neurologic disease.
        Adv Ther. 2005; 22: 659-678
        • Nighoghossian N.
        • Trouillas P.
        • Adeleine P.
        • Salord F.
        Hyperbaric oxygen in the treatment of acute ischemic stroke: a double-blind pilot study.
        Stroke. 1995; 26: 1369-1372
        • Taher A.
        • Pilehvari Z.
        • Poorolajal J.
        • Aghajanloo M.
        Effects of normobaric hyperoxia in traumatic brain injury: a randomized controlled clinical trial.
        Trauma Mon. 2016; 21: e26772
        • Rockswold S.B.
        • Rockswold G.L.
        • Zaun D.A.
        • Liu J.
        A prospective, randomized Phase II clinical trial to evaluate the effect of combined hyperbaric and normobaric hyperoxia on cerebral metabolism, intracranial pressure, oxygen toxicity, and clinical outcome in severe traumatic brain injury.
        J Neurosurg. 2013; 118: 1317-1328
        • Xu Q.
        • Wei Y.T.
        • Fan S.B.
        • Wang L.
        • Zhou X.P.
        Repetitive hyperbaric oxygen treatment increases insulin sensitivity in diabetes patients with acute intracerebral hemorrhage.
        Neuropsychiatr Dis Treat. 2017; 13: 421-426
        • Rusyniak D.E.
        • Kirk M.A.
        • May J.D.
        • Kao L.W.
        • Brizendine E.J.
        • Welch J.L.
        • et al.
        Hyperbaric oxygen in acute ischemic stroke trial pilot study. Hyperbaric oxygen therapy in acute ischemic stroke: results of the Hyperbaric Oxygen in Acute Ischemic Stroke Trial Pilot Study.
        Stroke. 2003; 34: 571-574
        • Wilkinson D.
        • Nolting M.
        • Mahadi M.K.
        • Chapman I.
        • Heilbronn L.
        Hyperbaric oxygen therapy increases insulin sensitivity in overweight men with and without type 2 diabetes.
        Diving Hyperb Med. 2015; 45: 30-36
        • Zhang J.H.
        • Lo T.
        • Mychaskiw G.
        • Colohan A.
        Mechanisms of hyperbaric oxygen and neuroprotection in stroke.
        Pathophysiology. 2005; 12: 63-77
        • Katzman R.
        • Clasen R.
        • Klatzo I.
        • Meyer J.S.
        • Pappius H.M.
        • Waltz A.G.
        Report of joint committee for stroke resources. IV. Brain edema in stroke.
        Stroke. 1977; 8: 512-540
        • Efrati S.
        • Ben-Jacob E.
        Reflections on the neurotherapeutic effects of hyperbaric oxygen.
        Expert Rev Neurother. 2014; 14: 233-236
        • Peleg R.K.
        • Fishlev G.
        • Bechor Y.
        • Bergan J2
        • Friedman M.
        • Koren S.
        • et al.
        Effects of hyperbaric oxygen on blood glucose levels in patients with diabetes mellitus, stroke or traumatic brain injury and healthy volunteers: a prospective, crossover, controlled trial.
        Diving Hyperb Med. 2013; 43: 218-221