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. 2021 Mar 10;25(1):99.
doi: 10.1186/s13054-021-03521-9.

Systematic review of cognitive impairment and brain insult after mechanical ventilation

Thiago G Bassi  1   2 , Elizabeth C Rohrs  1   3 , Steven C Reynolds  4   5
Affiliations

Systematic review of cognitive impairment and brain insult after mechanical ventilation

Thiago G Bassi et al. Crit Care. .

Abstract

We conducted a systematic review following the PRISMA protocol primarily to identify publications that assessed any links between mechanical ventilation (MV) and either cognitive impairment or brain insult, independent of underlying medical conditions. Secondary objectives were to identify possible gaps in the literature that can be used to inform future studies and move toward a better understanding of this complex problem. The preclinical literature suggests that MV is associated with neuroinflammation, cognitive impairment, and brain insult, reporting higher neuroinflammatory markers, greater evidence of brain injury markers, and lower cognitive scores in subjects that were ventilated longer, compared to those ventilated less, and to never-ventilated subjects. The clinical literature suggests an association between MV and delirium, and that delirium in mechanically ventilated patients may be associated with greater likelihood of long-term cognitive impairment; our systematic review found no clinical study that demonstrated a causal link between MV, cognitive dysfunction, and brain insult. More studies should be designed to investigate ventilation-induced brain injury pathways as well as any causative linkage between MV, cognitive impairment, and brain insult.

Keywords: Apoptosis; Brain injuries; Cognitive impairment; Delirium; Mechanical; Ventilators.

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Conflict of interest statement

ECR and SCR have received consulting fees from Lungpacer Medical, Inc. TGB is an employee of Lungpacer Medical, Inc. SCR is listed on a patent for Lungpacer Medical, Inc.

Figures

Fig. 1
Fig. 1
Systematic review process and results. a Review process for the preclinical papers. b Review process for the clinical papers
Fig. 2
Fig. 2
Forest plot showing the odds ratios for duration of MV as an independent variable associated with increased likelihood of delirium. The size of each black dot corresponds to the weight effect of the study in the meta-analysis. Red diamond represents the pooled odds ratio
Fig. 3
Fig. 3
Forest plot showing the odds ratios for delirium as an independent variable associated with increased likelihood of prolonged MV. The size of each black dot corresponds to the weight effect of the study in the meta-analysis. Red diamond represents the pooled odds ratio
Fig. 4
Fig. 4
Forest plot showing the odds ratios for delirium during MV as an independent variable associated with increased likelihood of long-term cognitive impairment. The size of each black dot corresponds to the weight effect of the study in the meta-analysis. Red diamond represents the pooled odds ratio
See this image and copyright information in PMC

References

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