Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2016; 5(1): 65-73
Published online Feb 4, 2016. doi: 10.5492/wjccm.v5.i1.65
Respiratory mechanics in brain injury: A review
Antonia Koutsoukou, Maria Katsiari, Stylianos E Orfanos, Anastasia Kotanidou, Maria Daganou, Magdalini Kyriakopoulou, Nikolaos G Koulouris, Nikoletta Rovina
Antonia Koutsoukou, Maria Daganou, Magdalini Kyriakopoulou, Nikoletta Rovina, ICU, First Department of Respiratory Medicine, University of Athens Medical School, Sotiria Hospital, 11527 Athens, Greece
Maria Katsiari, Intensive Care Unit, “Konstantopouleio” General Hospital of Nea Ionia, 14233 Athens, Greece
Stylianos E Orfanos, Second Department of Critical Care, University of Athens Medical School, Attikon Hospital, 12462 Athens, Greece
Anastasia Kotanidou, First Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, 10676 Athens, Greece
Nikolaos G Koulouris, First Department of Respiratory Medicine, University of Athens Medical School, Sotiria Hospital, 11527 Athens, Greece
Author contributions: All authors contributed to this paper; Koutsoukou A, Katsiari M, Orfanos SE and Rovina N designed the study; Koutsoukou A, Katsiari M, Kyriakopoulou M and Daganou M performed the literature review and analysis; Katsiari M, Koulouris NG and Rovina N wrote the paper; Koutsoukou A, Orfanos SE, Kotanidou A, Koulouris NG and Rovina N performed the critical revision and editing; all authors approved the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
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: Antonia Koutsoukou, Associate Professor, ICU, First Department of Respiratory medicine, University of Athens Medical School, Sotiria Hospital, Mesogion Av 152, 11527 Athens, Greece. koutsoukou@yahoo.gr
Telephone: +30-21-07763718 Fax: +30-21-07781250
Received: August 6, 2015
Peer-review started: August 10, 2015
First decision: September 16, 2015
Revised: October 8, 2015
Accepted: December 10, 2015
Article in press: December 11, 2015
Published online: February 4, 2016
Processing time: 169 Days and 17.7 Hours
Abstract

Several clinical and experimental studies have shown that lung injury occurs shortly after brain damage. The responsible mechanisms involve neurogenic pulmonary edema, inflammation, the harmful action of neurotransmitters, or autonomic system dysfunction. Mechanical ventilation, an essential component of life support in brain-damaged patients (BD), may be an additional traumatic factor to the already injured or susceptible to injury lungs of these patients thus worsening lung injury, in case that non lung protective ventilator settings are applied. Measurement of respiratory mechanics in BD patients, as well as assessment of their evolution during mechanical ventilation, may lead to preclinical lung injury detection early enough, allowing thus the selection of the appropriate ventilator settings to avoid ventilator-induced lung injury. The aim of this review is to explore the mechanical properties of the respiratory system in BD patients along with the underlying mechanisms, and to translate the evidence of animal and clinical studies into therapeutic implications regarding the mechanical ventilation of these critically ill patients.

Keywords: Brain damage; Respiratory mechanics; Positive end-expiratory pressure; Lung injury; Ventilator-induced lung injury

Core tip: Clinical and experimental evidence supports that preclinical lung injury occurs shortly after brain damage. Brain-damaged patients exhibit altered respiratory system mechanics and hypoxemia, even in the absence of clinically evident lung injury. Measurement of respiratory mechanics in such patients may reveal brain damage related lung injury early enough, and facilitate selection of the appropriate ventilator settings to avoid ventilator induced lung injury. Lung protective ventilation, consisting of low tidal volume and moderate levels of positive end-expiratory pressure, may prevent a further deterioration of respiratory dysfunction, and could be possibly associated with improved outcome.