ARDS associated acute brain injury: from the lung to the brain

Abstract

A complex interrelation between lung and brain in patients with acute lung injury (ALI) has been established by experimental and clinical studies during the last decades. Although, acute brain injury represents one of the most common insufficiencies in patients with ALI and acute respiratory distress syndrome (ARDS), the underlying pathophysiology of the observed crosstalk remains poorly understood due to its complexity. Specifically, it involves numerous pathophysiological parameters such as hypoxemia, neurological adverse events of lung protective ventilation, hypotension, disruption of the BBB, and neuroinflammation in such a manner that the brain of ARDS patients—especially hippocampus—becomes very vulnerable to develop secondary lung-mediated acute brain injury. A protective ventilator strategy could reduce or even minimize further systemic release of inflammatory mediators and thus maintain brain homeostasis. On the other hand, mechanical ventilation with low tidal volumes may lead to self-inflicted lung injury, hypercapnia and subsequent cerebral vasodilatation, increased cerebral blood flow, and intracranial hypertension. Therefore, by describing the pathophysiology of ARDS-associated acute brain injury we aim to highlight and discuss the possible influence of mechanical ventilation on ALI-associated acute brain injury.

Diaphragm neurostimulation reduces mechanical power and mitigates brain injury associated with MV and ARDS

“…We read the recently published review by Ziaka and Exadaktylos with great enthusiasm. The authors summarized the current knowledge regarding brain injury associated with acute respiratory distress syndrome (ARDS) extremely well [ 1 ]. They described the accepted mechanisms by which ARDS might result in brain injury and possibly acute and chronic cognitive impairment [ 1 ].…”

“…The authors summarized the current knowledge regarding brain injury associated with acute respiratory distress syndrome (ARDS) extremely well [ 1 ]. They described the accepted mechanisms by which ARDS might result in brain injury and possibly acute and chronic cognitive impairment [ 1 ]. Among the mechanisms described were systemic inflammation, hypoxemia, and adverse effects of mechanical ventilation (MV) [ 1 ].…”

“…They described the accepted mechanisms by which ARDS might result in brain injury and possibly acute and chronic cognitive impairment [ 1 ]. Among the mechanisms described were systemic inflammation, hypoxemia, and adverse effects of mechanical ventilation (MV) [ 1 ]. According to Ziaka and Exadaktylos’s review, the interaction between the patient and the ventilator might lead to brain injury due to individual susceptibility to the development of acute lung injury during MV [ 1 ].…”

“…Among the mechanisms described were systemic inflammation, hypoxemia, and adverse effects of mechanical ventilation (MV) [ 1 ]. According to Ziaka and Exadaktylos’s review, the interaction between the patient and the ventilator might lead to brain injury due to individual susceptibility to the development of acute lung injury during MV [ 1 ]. The authors postulated that this is a consequence of a disruption in the neural control of respiration and immunological response due to lung injury associated with ARDS [ 1 ].…”

“…According to Ziaka and Exadaktylos’s review, the interaction between the patient and the ventilator might lead to brain injury due to individual susceptibility to the development of acute lung injury during MV [ 1 ]. The authors postulated that this is a consequence of a disruption in the neural control of respiration and immunological response due to lung injury associated with ARDS [ 1 ]. The review stated that one possible cause of brain injury due to ARDS is a disruption in the conversion of the mechanical stimuli produced by the pulmonary stretch receptors during MV, which in turn results in an aberrant biological signal triggering brain injury [ 1 ].…”