Brain-lung crosstalk: Implications for neurocritical care patients

Abstract

Major pulmonary disorders may occur after brain injuries as ventilator-associated pneumonia, acute respiratory distress syndrome or neurogenic pulmonary edema. They are key points for the management of brain-injured patients because respiratory failure and mechanical ventilation seem to be a risk factor for increased mortality, poor neurological outcome and longer intensive care unit or hospital length of stay. Brain and lung strongly interact via complex pathways from the brain to the lung but also from the lung to the brain. Several hypotheses have been proposed with a particular interest for the recently described "double hit" model. Ventilator setting in brain-injured patients with lung injuries has been poorly studied and intensivists are often fearful to use some parts of protective ventilation in patients with brain injury. This review aims to describe the epidemiology and pathophysiology of lung injuries in brain-injured patients, but also the impact of different modalities of mechanical ventilation on the brain in the context of acute brain injury.

Keywords: Brain injury; Brain-lung crosstalk; Double hit model; Lung injury; Protective ventilation.

Figure 1

The double hit model in the context of brain injury. ARDS: Acute respiratory distress syndrome; PEEP: Positive end-expiratory pressure.

Figure 2

Algorithm approach for pulmonary dysfunction in brain-injured patient. ARDS: Acute respiratory distress syndrome; VAP: Ventilator-associated pneumonia; Vt: Tidal volume; PBW: Predictive body weight; NPE: Neurogenic pulmonary edema.