Pulmonary complications and respiratory management in neurocritical care: a narrative review

Abstract

Neurocritical care (NCC) is not only generally guided by principles of general intensive care, but also directed by specific goals and methods. This review summarizes the common pulmonary diseases and pathophysiology affecting NCC patients and the progress made in strategies of respiratory support in NCC. This review highlights the possible interactions and pathways that have been revealed between neurological injuries and respiratory diseases, including the catecholamine pathway, systemic inflammatory reactions, adrenergic hypersensitivity, and dopaminergic signaling. Pulmonary complications of neurocritical patients include pneumonia, neurological pulmonary edema, and respiratory distress. Specific aspects of respiratory management include prioritizing the protection of the brain, and the goal of respiratory management is to avoid inappropriate blood gas composition levels and intracranial hypertension. Compared with the traditional mode of protective mechanical ventilation with low tidal volume (Vt), high positive end-expiratory pressure (PEEP), and recruitment maneuvers, low PEEP might yield a potential benefit in closing and protecting the lung tissue. Multimodal neuromonitoring can ensure the safety of respiratory maneuvers in clinical and scientific practice. Future studies are required to develop guidelines for respiratory management in NCC.

Complicaciones y mortalidad en pacientes neurocríticos

“…Dentro de las complicaciones infecciosas la neumonía asociada a ventilación mecánica invasiva se reportó en el 26,15 % de todos los pacientes, con resultados similares a los descritos en la publicación de Wen JU (10) en 2022, además de la estrecha relación en la incidencia de complicaciones no infecciosas como alteraciones del ritmo cardiaco, trastornos ácido base, y delirio, entre otros. Es de hacer notar que en los pacientes que murieron la incidencia de NAV fue 46,66% (n=7/15) mientras que en el grupo de sobrevivientes la incidencia fue 20% (n=10/50).…”