Effi cacy and safety of carboxytherapy in patients with ischemic stroke

The modern integrated approach to the treatment of ischemic stroke (IS), in addition to pharmacotherapy, provides for the impact of physical factors. Among them is injectable carboxytherapy (ICBT).

Objective. The aim of the study was to evaluate the effi cacy and safety of using ICBT in combination with a standard treatment program in patients with acute ischemic stroke.

Material and methods. The main group (MG) included 39 patients with acute IS, the comparison group (GC) — 31 patients. On the second day of hospitalization, patients with MG underwent ICBT on the background of standard therapy, and GC — procedures that mimic ICBT. Clinical, laboratory and instrumental data, IS outcomes, complications, timing were assessed.

Results. There were no statistically signifi cant diff erences in physiological parameters (heart rate, blood pressure, SpO2) between MG and GC during and after the course of treatment. Positive dynamics of the neurological status was observed in both groups in the form of a decrease in the NIHSS score — in the MG from 6 to 4 (p = 0.047), in the GC — also from 6 to 4 (p = 0.25). In patients with MG, trophic disorders were less likely to develop in comparison with GC — 1 (2.6%) versus 6 (19.4%), p = 0.039. ICBT did not aff ect the duration of hospitalization of patients, the duration of treatment in the intensive care unit and carrying of resuscitation and also did not contribute to reducing mortality. Changes in the indicators of the acid-base state of the blood were compensatory in nature and did not lead to changes in the pH of the blood. The decrease in pH from 7.5 to 7.4 in 30–90 minutes after the procedures was a physiological reaction of the body to the introduction of CO2 and was not accompanied by negative consequences.

Conclusions. ICBT is a safe method, does not aff ect the duration of hospital stay and mortality, help lower the likelihood of complications.

1. Gerasimenko M.Ju., Afoshin S.A. Physical factors in the complex rehabilitation of patients with acute cerebrovascular accident (part 1). Physiotherapy, balneology and rehabilitation (Fizioterapija, bal’neologija i reabilitacija). 2011;(4):46–50 (Russian).

2. Gerasimenko M.Ju., Afoshin S.A. Physical factors in the complex rehabilitation of patients with acute cerebrovascular accident (part 2). Physiotherapy, balneology and rehabilitation (Fizioterapija, bal’neologija i reabilitacija). 2011;(5):52–57 (Russian).

3. Gerasimenko M.Ju., Afoshin S.A. Physical factors in the complex rehabilitation of patients with acute cerebrovascular accident (part 3). Physiotherapy, balneology and rehabilitation (Fizioterapija, bal’neologija i reabilitacija). 2011;(6):51–55. (Russian).

4. Покровский В.М., Коротько Г.Ф. Физиология человека: в 2 т. Т.1. Москва: Медицина, 1997:448 с. [Pokrovskiy V.M., Korot’ko G.F. Fiziologiya cheloveka: v 2 t. T.1. Moscow: Meditsina Publ., 1997:448 р. (Russian)].

5. Drogovoz S.M., Sctrygol S.Yu., Kononenko A.V., Zupanets M.V., Levinska O.V. Physiological properties of CO2 as substantiation of originality of carboxytherapy. Medicinal and clinical chemistry. (Meditsina i klinicheskaya khimiya). 2016;18(1):112–116. (Russian).

6. Taylor C.T., Cummins E.P. Regulation of gene expression by carbon dioxide. J. Physiol. 2011;589(4):797–803. https://doi. org/10.1113/jphysiol.2010.201467

7. Prakash K., Chandran D.S., Khadgawat R., Jaryal A.K., Deepak K.K. Correction for blood pressure improves correlation between cerebrovascular reactivity assessed by breath holding and 6% CO2 breathing. J. Strokе. Cerebrovasc. Dis. 2014;23(4):630–635. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.003

8. Drogovoz S.M. (red.) Karboksiterapiya: mekhanizmy, eff ekty, primenenie. Khar’kov: Titul Publ.; 2019:192 p. (Russian).

9. Drogovoz S.M., Shtrigol’ S.Yu., Kononenko A.V., Zupanets M.V., Shtroblya A.L. The mechanism of action of carboxytherapy. Pharmacology and toxicology. (Farmakologіya ta lіkars’ka toksikologіya). 2016;(6):12–20. (Ukraine).

10. Zenker S. Carboxytherapy: Carbon dioxide injections in aesthetic medicine. Prime J. 2012;2(1):42–50. Available at: https://www. plastikoperationer.net/wp-content/uploads/2013/02/Carboxytherapy-report.pdf [Accessed May 24, 2021]

11. Ospina-Tascon G.A., Bautista-Rincon D.F., Umana M., Tafur J.D, Gutierrez A., Garcia A.F. et al. Persistently high venous-to-arterial carbon dioxide diff erences during early resuscitation are associated with poor outcomes in septic shock. Crit Care. 2013;17(6):R294. https://doi.org/10.1186/сс13160

12. Hall E.L., Driver I.D., Croal P.L., Francis S.T., Gowland P.A., Morris P.G., Brookes M.J. The eff ect of hypercapnia on resting and stimulus induced MEG signals. Neuroimage. 2011;58(4):1034– 1043. https://doi.org/10.1016/j.neuroimage.2011.06.073

13. Drogovoz S.M., Shtrygol’ S.Yu., Zupanets M.V., Kononenko A.V., Levinskaya E.V. Carboxytherapy is an alternative to traditional pharmacotherapy. Clinical pharmacy. (Klinichna farmatsiya) 2016;20(1):12–17. (Ukraine)]. https://www.elibrary.ru/item.asp?id = 26023342

14. SpanoV.R., Mandell D.M., Poublanc J., Sam K., Battisti-Charbonney A., Pucci O. et al. CO2 blood oxygen level-dependent MR mapping of cerebrovascular reserve in a clinical population: safety, tolerability, and technical feasibility. Radiology. 2013;266(2):592–598. https://doi.org/10.1148/radiol.12112795

15. Bunyatyan N.D., Drogovoz S.M., Kononenko A.V., Zelenkova G., Prokof’ev A.B. Carboxytherapy is one of the innovative trends in balneology. Questions of balneology, physiotherapy and physical therapy. (Voprosy kurortologii, fi zioterapii i lechebnoy fi zicheskoy kul’tury). 2018;95(5):72–76 (Ukraine). https://doi.org/10.17116/kurort20189505172

16. Bunyatyan N.D., Drogovoz S.M., Shtroblya A.L., Kononenko A.V., Zelenkova G., Prokof’ev A.B. et al. The mechanism of the pulmonary protective action of carboxytherapy. Questions of balneology, physiotherapy and exercise therapy. (Voprosy kurortologii, fi zioterapii i lechebnoy fi zkul’tury). 2019;96(4):58–62. (Ukraine). https://doi.org/10.17116/kurort20199604158

17. Vinzhegina V.A. Correction of cardiac status in patients with ischemic heart disease in sanatorium rehabilitation conditions. International Journal of Medicine and Psychology. (Mezhdunarodnyy zhurnal meditsiny i psikhologii) 2019;2(4):22–26. (Russian). URL: http://ijmp.ru/archives/9622

18. Nach R., Zandifar H., Gupta R., Hamilton J.S. Subcutaneous carboxytherapy injection for aesthetic improvement of scars. Ear Nose Throat J. 2010;89(2):64–66.

19. Belkin A.A., Avdyunina I.A., Varako N.A., Zinchenko Yu.P., Voznyuk I.A., Davydova N.S. et al. Reabilitatsiya v intensivnoy terapii. In: Zabolotskikh I.B., Shifman E.M. (eds.) Russian Journal of Anаеsthesiology and Reanimatology/Anesteziologiya i Reanimatologiya. Guidelines. Moscow: GEOTARMedia Publ., 2016:874–928. (Russian).

20. Gélinas C., Bérubé M., Puntillo K.A., Boitor M., RichardLalonde M., Bernard F. et al. Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit: a prospective cohort study. Crit Care. 2021;25(1):142. https://doi.org/10.1186/s13054-021-03561-1