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Do acute stroke patients develop hypocapnia? A systematic review and meta-analysis.

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journal contribution
posted on 29.05.2019, 15:50 by ASM Salinet, JS Minhas, RB Panerai, E Bor-Seng-Shu, TG Robinson
PURPOSE: Carbon dioxide (CO2) is a potent cerebral vasomotor agent. Despite reduction in CO2 levels (hypocapnia) being described in several acute diseases, there is no clear data on baseline CO2 values in acute stroke. The aim of the study was to systematically assess CO2 levels in acute stroke. MATERIAL AND METHODS: Four online databases, Web of Science, MEDLINE, EMBASE and CENTRAL, were searched for articles that described either partial pressure of arterial CO2 (PaCO2) and end-tidal CO2 (EtCO2) in acute stroke. RESULTS: After screening, based on predefined inclusion and exclusion criteria, 20 studies were retained. There were 5 studies in intracerebral hemorrhage and 15 in ischemic stroke, totalling 660 stroke participants. Acute stroke was associated with a significant decrease in CO2 levels compared to controls. Cerebral haemodynamic studies using transcranial Doppler ultrasonography demonstrated a significant reduction in cerebral blood flow velocities and cerebral autoregulation in acute stroke patients. CONCLUSION: The evidence from this review suggests that acute stroke patients are significantly more likely than controls to be hypocapnic, supporting the value of routine CO2 assessment in the acute stroke setting. Further studies are required in order to evaluate the clinical impact of these findings.

Funding

Acknowledgements: JSM is Dunhill Medical Trust Clinical Research Training Fellow (RTF97/0117) at the Department of Cardiovascular Sciences, University of Leicester. Professor TG Robinson is a National Institute for Health Research Senior Investigator. The authors would like to thank Pip Divall for kindly providing input into the planning of the original search strategy. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

History

Citation

Journal of the Neurological Sciences, 2019, 402, pp. 30-39

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

Journal of the Neurological Sciences

Publisher

Elsevier for World Federation of Neurology

eissn

1878-5883

Acceptance date

29/04/2019

Copyright date

2019

Publisher version

https://www.sciencedirect.com/science/article/pii/S0022510X19302059?via=ihub

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en