Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke

Georgios Tsivgoulis, Yi Zhang, Anne Alexandrov, Mark R. Harrigan, April Sisson, Limin Zhao, Mary Brethour, Luis Cava, Clotilde Balucani, Kristian Barlinn, Damon E. Patterson, Sotirios Giannopoulos, Jennifer Dewolfe, Andrei Alexandrov

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background and Purpose- Hypercapnia can induce intracranial blood-flow steal from ischemic brain tissues, and early initiation of noninvasive ventilator correction (NIVC) may improve cerebral hemodynamics in acute ischemic stroke. We sought to determine safety and tolerability of NIVC initiated on hospital admission without polysomnography study. Subjects and Methods- Consecutive acute ischemic stroke patients were evaluated for the presence of a proximal arterial occlusion, daytime sleepiness, or history of obstructive sleep apnea, and acceptable pulse oximetry readings while awake (96%-100% on 2 to 4 L supplemental oxygen delivered by nasal cannula). NIVC was started on hospital admission as standard of care when considered necessary by treating physicians. NIVC was initiated using bilevel positive airway pressure at 10 cmH2O inspiratory positive airway pressure and 5 cmH2O expiratory positive airway pressure in combination with 40% fraction of inspired oxygen. All potential adverse events were prospectively documented. Results- Among 356 acute ischemic stroke patients (median NIHSS score, 5; interquartile range, 2-13), 64 cases (18%) received NIVC (median NIHSS score, 12; interquartile range, 6-17). Baseline stroke severity was higher and proximal arterial occlusions were more frequent in NIVC patients compared to the rest (P<0.001). NIVC was not tolerated by 4 patients (7%). Adverse events in NIVC included vomiting (n=1), aspiration pneumonia (n=1), respiratory failure/intubation (n=1), hypotension requiring pressors (n=1), and facial skin breakdown (n=3). The in-hospital mortality rate was 13% in NIVC patients and 8% in the rest (P=0.195). Neurological improvement during hospitalization tended to be greater in the NIVC group (median NIHSS score decrease, 2 points; interquartile range, 0-4) compared to the rest (median NIHSS score decrease, 1; interquartile range, 0-2; P=0.078). Conclusions- In acute ischemic stroke patients with proximal arterial occlusion and excessive sleepiness or obstructive sleep apnea, NIVC can be initiated early with good tolerability and a relatively small risk of serious complications.

Original languageEnglish (US)
Pages (from-to)1030-1034
Number of pages5
JournalStroke
Volume42
Issue number4
DOIs
StatePublished - Apr 1 2011

Fingerprint

Mechanical Ventilators
Stroke
Safety
Pressure
Obstructive Sleep Apnea
Oxygen
Aspiration Pneumonia
Oximetry
Hypercapnia
Polysomnography
Standard of Care
Hospital Mortality
Intubation
Respiratory Insufficiency
Hypotension
Vomiting
Reading
Hospitalization
Hemodynamics
Physicians

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke. / Tsivgoulis, Georgios; Zhang, Yi; Alexandrov, Anne; Harrigan, Mark R.; Sisson, April; Zhao, Limin; Brethour, Mary; Cava, Luis; Balucani, Clotilde; Barlinn, Kristian; Patterson, Damon E.; Giannopoulos, Sotirios; Dewolfe, Jennifer; Alexandrov, Andrei.

In: Stroke, Vol. 42, No. 4, 01.04.2011, p. 1030-1034.

Research output: Contribution to journalArticle

Tsivgoulis, G, Zhang, Y, Alexandrov, A, Harrigan, MR, Sisson, A, Zhao, L, Brethour, M, Cava, L, Balucani, C, Barlinn, K, Patterson, DE, Giannopoulos, S, Dewolfe, J & Alexandrov, A 2011, 'Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke', Stroke, vol. 42, no. 4, pp. 1030-1034. https://doi.org/10.1161/STROKEAHA.110.600221
Tsivgoulis, Georgios ; Zhang, Yi ; Alexandrov, Anne ; Harrigan, Mark R. ; Sisson, April ; Zhao, Limin ; Brethour, Mary ; Cava, Luis ; Balucani, Clotilde ; Barlinn, Kristian ; Patterson, Damon E. ; Giannopoulos, Sotirios ; Dewolfe, Jennifer ; Alexandrov, Andrei. / Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke. In: Stroke. 2011 ; Vol. 42, No. 4. pp. 1030-1034.
@article{557e639dc0a24fde87190b03e806fccf,
title = "Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke",
abstract = "Background and Purpose- Hypercapnia can induce intracranial blood-flow steal from ischemic brain tissues, and early initiation of noninvasive ventilator correction (NIVC) may improve cerebral hemodynamics in acute ischemic stroke. We sought to determine safety and tolerability of NIVC initiated on hospital admission without polysomnography study. Subjects and Methods- Consecutive acute ischemic stroke patients were evaluated for the presence of a proximal arterial occlusion, daytime sleepiness, or history of obstructive sleep apnea, and acceptable pulse oximetry readings while awake (96{\%}-100{\%} on 2 to 4 L supplemental oxygen delivered by nasal cannula). NIVC was started on hospital admission as standard of care when considered necessary by treating physicians. NIVC was initiated using bilevel positive airway pressure at 10 cmH2O inspiratory positive airway pressure and 5 cmH2O expiratory positive airway pressure in combination with 40{\%} fraction of inspired oxygen. All potential adverse events were prospectively documented. Results- Among 356 acute ischemic stroke patients (median NIHSS score, 5; interquartile range, 2-13), 64 cases (18{\%}) received NIVC (median NIHSS score, 12; interquartile range, 6-17). Baseline stroke severity was higher and proximal arterial occlusions were more frequent in NIVC patients compared to the rest (P<0.001). NIVC was not tolerated by 4 patients (7{\%}). Adverse events in NIVC included vomiting (n=1), aspiration pneumonia (n=1), respiratory failure/intubation (n=1), hypotension requiring pressors (n=1), and facial skin breakdown (n=3). The in-hospital mortality rate was 13{\%} in NIVC patients and 8{\%} in the rest (P=0.195). Neurological improvement during hospitalization tended to be greater in the NIVC group (median NIHSS score decrease, 2 points; interquartile range, 0-4) compared to the rest (median NIHSS score decrease, 1; interquartile range, 0-2; P=0.078). Conclusions- In acute ischemic stroke patients with proximal arterial occlusion and excessive sleepiness or obstructive sleep apnea, NIVC can be initiated early with good tolerability and a relatively small risk of serious complications.",
author = "Georgios Tsivgoulis and Yi Zhang and Anne Alexandrov and Harrigan, {Mark R.} and April Sisson and Limin Zhao and Mary Brethour and Luis Cava and Clotilde Balucani and Kristian Barlinn and Patterson, {Damon E.} and Sotirios Giannopoulos and Jennifer Dewolfe and Andrei Alexandrov",
year = "2011",
month = "4",
day = "1",
doi = "10.1161/STROKEAHA.110.600221",
language = "English (US)",
volume = "42",
pages = "1030--1034",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke

AU - Tsivgoulis, Georgios

AU - Zhang, Yi

AU - Alexandrov, Anne

AU - Harrigan, Mark R.

AU - Sisson, April

AU - Zhao, Limin

AU - Brethour, Mary

AU - Cava, Luis

AU - Balucani, Clotilde

AU - Barlinn, Kristian

AU - Patterson, Damon E.

AU - Giannopoulos, Sotirios

AU - Dewolfe, Jennifer

AU - Alexandrov, Andrei

PY - 2011/4/1

Y1 - 2011/4/1

N2 - Background and Purpose- Hypercapnia can induce intracranial blood-flow steal from ischemic brain tissues, and early initiation of noninvasive ventilator correction (NIVC) may improve cerebral hemodynamics in acute ischemic stroke. We sought to determine safety and tolerability of NIVC initiated on hospital admission without polysomnography study. Subjects and Methods- Consecutive acute ischemic stroke patients were evaluated for the presence of a proximal arterial occlusion, daytime sleepiness, or history of obstructive sleep apnea, and acceptable pulse oximetry readings while awake (96%-100% on 2 to 4 L supplemental oxygen delivered by nasal cannula). NIVC was started on hospital admission as standard of care when considered necessary by treating physicians. NIVC was initiated using bilevel positive airway pressure at 10 cmH2O inspiratory positive airway pressure and 5 cmH2O expiratory positive airway pressure in combination with 40% fraction of inspired oxygen. All potential adverse events were prospectively documented. Results- Among 356 acute ischemic stroke patients (median NIHSS score, 5; interquartile range, 2-13), 64 cases (18%) received NIVC (median NIHSS score, 12; interquartile range, 6-17). Baseline stroke severity was higher and proximal arterial occlusions were more frequent in NIVC patients compared to the rest (P<0.001). NIVC was not tolerated by 4 patients (7%). Adverse events in NIVC included vomiting (n=1), aspiration pneumonia (n=1), respiratory failure/intubation (n=1), hypotension requiring pressors (n=1), and facial skin breakdown (n=3). The in-hospital mortality rate was 13% in NIVC patients and 8% in the rest (P=0.195). Neurological improvement during hospitalization tended to be greater in the NIVC group (median NIHSS score decrease, 2 points; interquartile range, 0-4) compared to the rest (median NIHSS score decrease, 1; interquartile range, 0-2; P=0.078). Conclusions- In acute ischemic stroke patients with proximal arterial occlusion and excessive sleepiness or obstructive sleep apnea, NIVC can be initiated early with good tolerability and a relatively small risk of serious complications.

AB - Background and Purpose- Hypercapnia can induce intracranial blood-flow steal from ischemic brain tissues, and early initiation of noninvasive ventilator correction (NIVC) may improve cerebral hemodynamics in acute ischemic stroke. We sought to determine safety and tolerability of NIVC initiated on hospital admission without polysomnography study. Subjects and Methods- Consecutive acute ischemic stroke patients were evaluated for the presence of a proximal arterial occlusion, daytime sleepiness, or history of obstructive sleep apnea, and acceptable pulse oximetry readings while awake (96%-100% on 2 to 4 L supplemental oxygen delivered by nasal cannula). NIVC was started on hospital admission as standard of care when considered necessary by treating physicians. NIVC was initiated using bilevel positive airway pressure at 10 cmH2O inspiratory positive airway pressure and 5 cmH2O expiratory positive airway pressure in combination with 40% fraction of inspired oxygen. All potential adverse events were prospectively documented. Results- Among 356 acute ischemic stroke patients (median NIHSS score, 5; interquartile range, 2-13), 64 cases (18%) received NIVC (median NIHSS score, 12; interquartile range, 6-17). Baseline stroke severity was higher and proximal arterial occlusions were more frequent in NIVC patients compared to the rest (P<0.001). NIVC was not tolerated by 4 patients (7%). Adverse events in NIVC included vomiting (n=1), aspiration pneumonia (n=1), respiratory failure/intubation (n=1), hypotension requiring pressors (n=1), and facial skin breakdown (n=3). The in-hospital mortality rate was 13% in NIVC patients and 8% in the rest (P=0.195). Neurological improvement during hospitalization tended to be greater in the NIVC group (median NIHSS score decrease, 2 points; interquartile range, 0-4) compared to the rest (median NIHSS score decrease, 1; interquartile range, 0-2; P=0.078). Conclusions- In acute ischemic stroke patients with proximal arterial occlusion and excessive sleepiness or obstructive sleep apnea, NIVC can be initiated early with good tolerability and a relatively small risk of serious complications.

UR - http://www.scopus.com/inward/record.url?scp=79954598770&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79954598770&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.110.600221

DO - 10.1161/STROKEAHA.110.600221

M3 - Article

VL - 42

SP - 1030

EP - 1034

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 4

ER -