Pulmonary complications in patients with severe brain injury

Abstract

Pulmonary complications are prevalent in the critically ill neurological population. Respiratory failure, pneumonia, acute lung injury and the acute respiratory distress syndrome (ALI/ARDS), pulmonary edema, pulmonary contusions and pneumo/hemothorax, and pulmonary embolism are frequently encountered in the setting of severe brain injury. Direct brain injury, depressed level of consciousness and inability to protect the airway, disruption of natural defense barriers, decreased mobility, and secondary neurological insults inherent to severe brain injury are the main cause of pulmonary complications in critically ill neurological patients. Prevention strategies and current and future therapies need to be implemented to avoid and treat the development of these life-threatening medical complications.

Figure 1

Chest X-ray of an ARDS victim who has developed multiple pneumothoraces secondary to a bronchopleural fistula.

Figure 2

Chest X-ray of an ARDS victim that suffered a grade 4 SAH.

Figure 3

Pulmonary edema from volume overload as complication of Triple H Therapy in a patient with Grade 4 SAH. Note distended pulmonary arteries and prominent cardiac silhouette.

Figure 4

Saddle pulmonary embolism (white arrow) in a patient with SAH.