Supplemental Oxygen Use in Ischemic Stroke Patients, Does Utilization Correspond to Need for Oxygen Therapy?
Background: In 1994, the American Heart Association Stroke Council stated that there is no data to support routine use of supplemental oxygen in stroke patients. The purpose of this study was to determine the degree of supplemental oxygen use in ischemic stroke and whether patients receiving oxygen met criteria for therapy. Methods: An extensive literature search was performed to generate a comprehensive list of explicit criteria for supplemental oxygen use. When the literature disagreed, criteria were included in the list to overestimate rather than underestimate the justification for oxygen use. A retrospective chart review of 169 consecutive, non-intubated, ischemic stroke patients admitted to a university hospital during calendar year 1998 was performed. Two patients were excluded due to missing data yielding a sample of 167 patients. Data included demographic and co-morbidity information as well as a check of each inpatient day for documentation of any of the explicit criteria for supplemental oxygen use. Results: A total of 167 patient charts were reviewed yielding a total of 600 inpatient days abstracted. Of the 167 patients, 102 (61.1%) received oxygen accounting for 322 patient days. Of the 322 inpatient days that patients received oxygen, 147 (45.6%) met at least one criteria for oxygen utilization. Of the 278 inpatient days that patients did not receive oxygen 69 (24.8%) would have met at least one of the criteria for oxygen use. For the entire population, statistically significant factors associated with patients receiving oxygen included: presence of at least one justifying criteria, increasing age, white race, male gender, history of atrial fibrillation, and a history of hypertension. Conclusion: We developed a comprehensive, literature-based list of criteria for supplemental oxygen therapy that was designed to overestimate rather than underestimate the justification of oxygen utilization. Using this explicit list, only 45.6% of days of oxygen therapy were justified in our ischemic stroke population. This study demonstrates that oxygen therapy is commonly given to ischemic stroke victims without clear indication.