{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T19:10:10Z","timestamp":1736881810094,"version":"3.33.0"},"reference-count":14,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Aeromedical transfer of patients with ischemic stroke to access hyperacute stroke treatment is becoming increasingly common. Little is known about how rapid changes of altitude and atmospheric pressure can impact cerebral perfusion and ischemic burden. In patients with ischemic stroke, there is a theoretical possibility that this physiologic response of hypoxia-driven hyperventilation at higher altitude can lead to a relative drop in PaCO<jats:sub>2<\/jats:sub>. This would ultimately result in cerebral vasoconstriction, and therefore worsening of the ischemic burden in patients with ischemic stroke. Currently, there are no specific recommendations in stroke guidelines for optimizing altitude of aeromedical transportation to minimize the rate of ischemic burden. In this scoping review, we aim to map the available literature that addressed whether PaCO<jats:sub>2<\/jats:sub> changes with altitude. This would be the steppingstone for more in-depth analyses into the cerebral autoregulatory consequences of high altitude on cerebral ischemia to form future guidelines.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and analysis<\/jats:title>\n<jats:p>We will follow scoping review methods recommended by the Joanna Briggs Institute. Electronic databases MEDLINE, Embase, Web of Science, and Cochrane Central Register of Systematic will be systematically searched to identify articles that report on the acute response of PaCO<jats:sub>2<\/jats:sub> on acute change in altitude. Two independent investigators will perform duplicate title and abstract screening and full-text review, followed by duplicate data extraction. We will present quantitative data using descriptive statistics. Key textual information will be synthesized in a tabular format Simple statistics on the frequency of papers, data will be presented via histogram.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Ethics and dissemination<\/jats:title>\n<jats:p>This scoping review does not require ethical approval. The results of our scoping review will be published in academic medical journals and presented at medical conferences. The findings will highlight the current availability of literature on PaCO<jats:sub>2<\/jats:sub> changes with altitude.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Registration<\/jats:title>\n<jats:p>This scoping review protocol has been registered in Open Science Framework (DOI <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/UVK83\" xlink:type=\"simple\">10.17605\/OSF.IO\/UVK83<\/jats:ext-link>).<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0316608","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T18:28:37Z","timestamp":1736879317000},"page":"e0316608","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A scoping review protocol on brain PaCO2 levels at altitude"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2840-8609","authenticated-orcid":true,"given":"Hanna","family":"Tang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7906-3631","authenticated-orcid":true,"given":"Laurel","family":"Charlesworth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoj","family":"Lalu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Dewar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Risa","family":"Shorr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dariush","family":"Dowlatshahi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"issue":"12","key":"pone.0316608.ref001","doi-asserted-by":"crossref","first-page":"2580","DOI":"10.1161\/01.STR.30.12.2580","article-title":"Helicopter transfer offers a potential benefit to patients with acute stroke","volume":"30","author":"MB Conroy","year":"1999","journal-title":"Stroke"},{"issue":"6","key":"pone.0316608.ref002","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.amj.2023.06.007","article-title":"Air Medical Transport for Acute Ischemic Stroke Patients: A Retrospective Cohort Study of National Trends Over an 8-Year Period.","volume":"42","author":"A Urdaneta","year":"2023","journal-title":"Air Medical Journal."},{"issue":"1","key":"pone.0316608.ref003","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1706442","article-title":"Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct","volume":"378","author":"RG Nogueira","year":"2018","journal-title":"New England Journal of Medicine"},{"key":"pone.0316608.ref004","doi-asserted-by":"crossref","first-page":"768381","DOI":"10.3389\/fneur.2021.768381","article-title":"Optimal transport scenario with rotary air transport for access to endovascular therapy considering patient outcomes and cost: a modeling study.","volume":"12","author":"A Wheaton","year":"2021","journal-title":"Frontiers in Neurology"},{"issue":"7165","key":"pone.0316608.ref005","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1136\/bmj.317.7165.1063","article-title":"Oxygen at high altitude","volume":"317","author":"AJ Peacock","year":"1998","journal-title":"BMJ"},{"issue":"1","key":"pone.0316608.ref006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2049-6958-6-1-14","article-title":"The lung at high altitude","volume":"6","author":"A. Cogo","year":"2011","journal-title":"Multidisciplinary Respiratory Medicine"},{"key":"pone.0316608.ref007","first-page":"1","article-title":"Canadian stroke best practice recommendations: acute stroke management, practice guidelines update, 2022.","volume":"19","author":"M Heran","year":"2022","journal-title":"Canadian Journal of Neurological Sciences."},{"key":"pone.0316608.ref008","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association.","author":"WJ Powers","year":"2019","journal-title":"Stroke"},{"issue":"1","key":"pone.0316608.ref009","doi-asserted-by":"crossref","first-page":"I","DOI":"10.1177\/2396987321989865","article-title":"European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke.","volume":"6","author":"E Berge","year":"2021","journal-title":"European Stroke Journal."},{"issue":"1","key":"pone.0316608.ref010","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/2396987319832140","article-title":"European stroke organisation (ESO)\u2013European society for minimally invasive neurological therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischaemic Stroke Endorsed by stroke alliance for Europe (SAFE).","volume":"4","author":"G Turc","year":"2019","journal-title":"European Stroke Journal."},{"key":"pone.0316608.ref011","volume-title":"Clinical guidelines for stroke management 2021.","author":"National Stroke Foundation (Australia","year":"2021"},{"issue":"4","key":"pone.0316608.ref012","doi-asserted-by":"crossref","first-page":"953","DOI":"10.11124\/JBIES-21-00242","article-title":"Best practice guidance and reporting items for the development of scoping review protocols","volume":"20","author":"MD Peters","year":"2022","journal-title":"JBI Evidence Synthesis"},{"key":"pone.0316608.ref013","first-page":"40","article-title":"PRESS peer review of electronic search strategies: 2015 guideline statement","volume":"75","author":"J McGowan","year":"2016","journal-title":"Journal of Cinical Epidemiology"},{"issue":"7","key":"pone.0316608.ref014","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.","volume":"169","author":"AC Tricco","year":"2018","journal-title":"Annals of Internal Medicine"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316608","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T18:28:44Z","timestamp":1736879324000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316608"}},"subtitle":[],"editor":[{"given":"Masaki","family":"Mogi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0316608","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,14]]}}}