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

Angela S M Salinet1, Jatinder S Minhas2, Ronney B Panerai3

  • 1Neurology Department, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Biomedical Engineering, Engineering, Modelling and Applied Social Sciences Centre, Federal ABC University, Sao Bernardo do Campo, Brazil.

Journal of the Neurological Sciences
|May 19, 2019
PubMed
Summary

Acute stroke patients often have lower carbon dioxide (CO2) levels, a condition known as hypocapnia. This systematic review highlights the need for routine CO2 assessment in acute stroke cases.

Keywords:
Acute strokeCarbon dioxideCerebral hemodynamicsHypocapniaMeta regressionSystematic review

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Area of Science:

  • Neurology
  • Critical Care Medicine
  • Vascular Medicine

Background:

  • Carbon dioxide (CO2) is a critical cerebral vasomotor agent.
  • Hypocapnia (reduced CO2 levels) is observed in various acute conditions.
  • Baseline CO2 data in acute stroke patients remains unclear.

Purpose of the Study:

  • To systematically evaluate baseline CO2 levels in patients with acute stroke.
  • To investigate the association between acute stroke and CO2 concentrations.
  • To determine the prevalence of hypocapnia in acute stroke.

Main Methods:

  • Systematic literature search of four databases: Web of Science, MEDLINE, EMBASE, and CENTRAL.
  • Inclusion of studies measuring partial pressure of arterial CO2 (PaCO2) and end-tidal CO2 (EtCO2) in acute stroke.
  • Screening of articles based on predefined inclusion and exclusion criteria.

Main Results:

  • 20 studies involving 660 participants (5 intracerebral hemorrhage, 15 ischemic stroke) were included.
  • Acute stroke patients exhibited significantly decreased CO2 levels compared to controls.
  • Reduced cerebral blood flow velocities and impaired cerebral autoregulation were observed in stroke patients.

Conclusions:

  • Acute stroke is strongly associated with hypocapnia.
  • Routine CO2 assessment is valuable in the acute stroke setting.
  • Further research is needed to clarify the clinical implications of these findings.