Brain–lung interactions and mechanical ventilation in patients with isolated brain injury
Open Access
- 13 October 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 25 (1), 1-10
- https://doi.org/10.1186/s13054-021-03778-0
Abstract
During the last decade, experimental and clinical studies have demonstrated that isolated acute brain injury (ABI) may cause severe dysfunction of peripheral extracranial organs and systems. Of all potential target organs and systems, the lung appears to be the most vulnerable to damage after brain injury (BI). The pathophysiology of these brain–lung interactions are complex and involve neurogenic pulmonary oedema, inflammation, neurodegeneration, neurotransmitters, immune suppression and dysfunction of the autonomic system. The systemic effects of inflammatory mediators in patients with BI create a systemic inflammatory environment that makes extracranial organs vulnerable to secondary procedures that enhance inflammation, such as mechanical ventilation (MV), surgery and infections. Indeed, previous studies have shown that in the presence of a systemic inflammatory environment, specific neurointensive care interventions—such as MV—may significantly contribute to the development of lung injury, regardless of the underlying mechanisms. Although current knowledge supports protective ventilation in patients with BI, it must be born in mind that ABI-related lung injury has distinct mechanisms that involve complex interactions between the brain and lungs. In this context, the role of extracerebral pathophysiology, especially in the lungs, has often been overlooked, as most physicians focus on intracranial injury and cerebral dysfunction. The present review aims to fill this gap by describing the pathophysiology of complications due to lung injuries in patients with a single ABI, and discusses the possible impact of MV in neurocritical care patients with normal lungs.Keywords
This publication has 136 references indexed in Scilit:
- Impact of Ventilator Adjustment and Sedation–Analgesia Practices on Severe Asynchrony in Patients Ventilated in Assist-Control Mode*Critical Care Medicine, 2013
- New perspectives on central and peripheral immune responses to acute traumatic brain injuryJournal of Neuroinflammation, 2012
- Neurogenic pulmonary edemaCritical Care, 2012
- Acute effects of intracranial hypertension and ARDS on pulmonary and neuronal damage: a randomized experimental study in pigsIntensive Care Medicine, 2011
- The lung and the brain: a dangerous cross-talkCritical Care, 2011
- Interferon-β attenuates lung inflammation following experimental subarachnoid hemorrhageCritical Care, 2010
- Bench-to-bedside review: Brain-lung interaction in the critically ill – a pending issue revisitedCritical Care, 2007
- Microglia Potentiate Damage to Blood–Brain Barrier ConstituentsStroke, 2006
- The Hemodynamic Mechanisms of Lung Injury and Systemic Inflammatory Response Following Brain Death in the Transplant DonorAmerican Journal of Transplantation, 2005
- Enhanced pulmonary inflammation in organ donors following fatal non-traumatic brain injuryThe Lancet, 1999