Brain-lung interaction: a vicious cycle in traumatic brain injury

Abstract

The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the "blast injury" theory or "double hit" model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury.

The role of cardiac dysfunction and post-traumatic pulmonary embolism in brain-lung interactions following traumatic brain injury

“…We agree with Chacón-Aponte et al [ 1 ] that in patients with an acute traumatic head injury, altered pulmonary function is a frequent complication. NPE is a probable early contributor to the pulmonary dysfunction that occurs in patients suffering from acute head injuries.…”

“…We read with immense interest the recent published narrative review by Chacón-Aponte et al [ 1 ] which concluded that brain-lung interactions can affect patients with traumatic brain injury (TBI). This interaction leads to a cruel cycle that aggravates patient prognosis.…”

“…This interaction leads to a cruel cycle that aggravates patient prognosis. According to these authors [ 1 ], the mechanisms of the interaction are complex and not fully explained. These authors [ 1 ] proposed two theories, the “blast injury” theory or “double hit” model, to represent the basis of its development and progression.…”

“…According to these authors [ 1 ], the mechanisms of the interaction are complex and not fully explained. These authors [ 1 ] proposed two theories, the “blast injury” theory or “double hit” model, to represent the basis of its development and progression. The authors explained that the brain and lungs strongly interact through complex pathways from the brain to the lungs and vice versa.…”

“…For Chacón-Aponte et al [ 1 ], the main pulmonary disorders that occur after brain injury are neurogenic pulmonary edema (NPE), acute respiratory distress syndrome, and ventilator-associated pneumonia, and the major brain consequences after lung injury can be explained by brain hypoxia and associated intracranial hypertension. Consequently, all of these conditions should be considered as management therapies after TBI and require special monitoring to avoid neurological and pulmonary complications.…”