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Neurocritical Care
Published in: Neurocritical Care 3/2009

01-12-2009 | Review

Acute Lung Injury in Patients with Severe Brain Injury: A Double Hit Model

Author: Luciana Mascia

Published in: Neurocritical Care | Issue 3/2009

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Abstract

The presence of pulmonary dysfunction after brain injury is well recognized. Acute lung injury (ALI) occurs in 20% of patients with isolated brain injury and is associated with a poor outcome. The “blast injury” theory, which proposes combined “hydrostatic” and “high permeability” mechanisms for the formation of neurogenic pulmonary edema, has been challenged recently by the observation that a systemic inflammatory response may play an integral role in the development of pulmonary dysfunction associated with brain injury. As a result of the primary cerebral injury, a systemic inflammatory reaction occurs, which induces an alteration in blood–brain barrier permeability and infiltration of activated neutrophils into the lung. This preclinical injury makes the lungs more susceptible to the mechanical stress of an injurious ventilatory strategy. Tight CO2 control is a therapeutic priority in patients with acute brain injury, but the use of high tidal volume ventilation may contribute to the development of ALI. Establishment of a therapeutic regimen that allows the combination of protective ventilation with the prevention of hypercapnia is, therefore, required. Moreover, in patients with brain injury, hypoxemia represents a secondary insult associated with a poor outcome. Optimal oxygenation may be achieved by using an adequate FiO2 and by application of positive end-expiratory pressure (PEEP). PEEP may, however, affect the cerebral circulation by hemodynamic and CO2-mediated mechanisms and the effects of PEEP on cerebral hemodynamics should be monitored in these patients and used to titrate its application.
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Metadata
Title
Acute Lung Injury in Patients with Severe Brain Injury: A Double Hit Model
Author
Luciana Mascia
Publication date
01-12-2009
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 3/2009
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-009-9242-8

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