Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Thursday, May 3, 2018

Mortality and morbidity in acutely ill adults treated with liberal vs conservative oxygen therapy (IOTA): A systematic review and meta-analysis

Useless since they excluded HBOT from the research.
https://www.mdlinx.com/internal-medicine/medical-news-article/2018/05/01/oxygen-therapy-acutely-ill-adults-systematic/7512097/?
The Lancet | May 01, 2018
Chu DK, et al. - The efficacy and safety of liberal vs conservative oxygen therapy were systematically reviewed in acutely ill adults. Researchers gained high-quality evidence indicating that liberal oxygen therapy increases mortality without improving other patient-important outcomes. Above saturation of peripheral oxygen range of 94–96%, supplemental oxygen might become unfavourable. The conservative administration of oxygen therapy was thus supported.

Methods

  • Researchers searched for randomised controlled trials comparing liberal and conservative oxygen therapy in acutely ill adults (aged ≥18 years) via inquiring the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, HealthSTAR, LILACS, PapersFirst, and the WHO International Clinical Trials Registry from inception to Oct 25, 2017, in the Improving Oxygen Therapy in Acute-illness (IOTA) systematic review and meta-analysis.
  • They limited the studies to patients with chronic respiratory diseases or psychiatric disease; patients on extracorporeal life support, or patients treated with hyperbaric oxygen therapy or elective surgery were excluded.
  • Studies were screened and summary estimates were extracted independently and in duplicate.
  • Individual patient-level data from survival curves was also extracted.
  • Mortality (in-hospital, at 30 days, and at longest follow-up) and morbidity (disability at longest follow-up, risk of hospital-acquired pneumonia, any hospital-acquired infection, and length of hospital stay) assessed by random-effects meta-analyses were the main outcomes.
  • Quality of evidence was assessed using the grading of recommendations assessment, development, and evaluation approach. 

Results

  • Researchers identified 25 randomised controlled trials enrolling 16,037 patients with sepsis, critical illness, stroke, trauma, myocardial infarction, or cardiac arrest, and patients who had emergency surgery.
  • They noted that in comparison to a conservative oxygen strategy, a liberal oxygen strategy (median baseline saturation of peripheral oxygen [SpO2] across trials, 96% [range 94–99%, IQR 96–98]) increased mortality in-hospital (relative risk [RR] 1·21, 95% CI 1·03–1·43, I2=0%, high quality), at 30 days (RR 1·14, 95% CI 1·01–1·29, I2=0%, high quality), and at longest follow-up (RR 1·10, 95% CI 1·00–1·20, I2=0%, high quality).
  • The groups were similar in terms of morbidity outcomes.
  • Findings were noted to be robust to trial sequential, subgroup, and sensitivity analyses.
Read the full article on The Lancet

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