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Comment & Response
February 6, 2018

Prophylactic Low-Dose Oxygen for Patients With Acute Stroke

Author Affiliations
  • 1Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan
  • 2Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts
JAMA. 2018;319(5):501-502. doi:10.1001/jama.2017.20342

To the Editor Dr Roffe and colleagues reported that prophylactic low-dose oxygen therapy during the first 3 days after stroke in nonhypoxic adults did not reduce disability or death at 3 months.1

Hypoxia has been identified as a common companion of acute stroke, and it has been reported in 63% of patients with acute hemiparetic stroke.2,3 Severity of stroke is one of the main factors for development of hypoxia.3 Moreover, patients with total anterior circulation syndrome develop the greatest rate of hypoxia among different ischemic stroke types.4 Supplemental oxygen could theoretically improve outcomes by preventing hypoxia and delayed cell death due to vasogenic edema or inflammation.1 However, in the Stroke Oxygen Study Trial (So2S), many patients had mild strokes (median National Institutes of Health Stroke Scale [NIHSS] score, 5 [interquartile range {IQR}, 3-9]), which suggests that a low number of patients had large vessel occlusion. Theoretically, stroke patients with milder stroke would be at less risk for hypoxia or vasogenic edema early after acute stroke.