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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2015; 4(3): 163-178
Published online Aug 4, 2015. doi: 10.5492/wjccm.v4.i3.163
Brain-lung crosstalk: Implications for neurocritical care patients
Ségolène Mrozek, Jean-Michel Constantin, Thomas Geeraerts
Ségolène Mrozek, Thomas Geeraerts, Anesthesiology and Critical Care Department, Equipe d’accueil “Modélisation de l’agression tissulaire et nociceptive”, University Hospital of Toulouse, 31000 Toulouse, France
Jean-Michel Constantin, Department of Anesthesiology and Critical Care Medicine, Estaing Hospital, University Hospital of Clermont-Ferrand, 63000 Clermont-Ferrand, France
Author contributions: Mrozek S, Constantin JM and Geeraerts T contributed equally to this paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ségolène Mrozek, MD, Anesthesiology and Critical Care Department, Equipe d’accueil “Modélisation de l’agression tissulaire et nociceptive”, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France. mrozek.s@chu-toulouse.fr
Telephone: +33-561-772167 Fax: +33-561-772170
Received: February 8, 2015
Peer-review started: February 9, 2015
First decision: April 10, 2015
Revised: May 8, 2015
Accepted: May 27, 2015
Article in press: May 28, 2015
Published online: August 4, 2015
Processing time: 190 Days and 0 Hours
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-lung crosstalk; Brain injury; Lung injury; Protective ventilation; Double hit model

Core tip: Brain lung crosstalk is a complex interaction from the brain to the lung but also from the lung to the brain. Intensivists are often fearful to use some parts of protective ventilation in patients with brain injuries but if correctly applied, mechanical ventilation could have beneficial effect on brain oxygenation, even if positive end-expiratory pressure and recruitment maneuvers are used. 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.