Unlocking the brain-lung dialogue key to future treatments for critical care patients VentilatoryManagement BrainInjury CriticalLink Healthcare Neurology CriticalCare BrainHealth Neurology BMCMedicine BioMedCentral
By Pooja Toshniwal PahariaMay 29 2023Reviewed by Benedette Cuffari, M.Sc. Previous research has highlighted the importance of brain-lung interaction in critically unwell individuals.
How do the lungs and brain interact? ABI can precipitate lung injury and modulate pulmonary physiology through several mechanisms, including elevated intracranial pressure , systemic inflammatory response, hormonal dysregulation, catecholamine surges, and dysregulated central breathing control. ARDS is frequently reported among critically ill ABI patients and can result in adverse consequences. However, ARDS investigations have excluded individuals with neurological illnesses, notably those with increased ICP. The risk of ICP increases due to pulmonary protective ventilation, prone position , or increased positive end-expiratory pressure levels among individuals with ARDS and ABI.
Several studies assessing the impact of positive end-expiratory pressure on ICP have yielded conflicting results. For example, some studies have reported that cerebral perfusion pressure and ICP are mediated by PEEP-based reductions in average arterial pressure and cardiac output. Comparatively, other studies reported that PEEP-mediated ICP increases tend to occur among individuals with poor pulmonary conformity.
Cerebral and pulmonary pathophysiology are intimately connected through complex and often bi-directional pathways that remain unclear. Different arterial blood gas targets may be needed in some patients to minimize secondary ischemic brain injury, optimize ICP, or enhance cerebral perfusion.
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