The lung and the brain: a dangerous cross-talk

Paolo Pelosi, Patricia R M Rocco, Paolo Pelosi, Patricia R M Rocco

Abstract

Brain or lung injury or both are frequent causes of admission to intensive care units and are associated with high morbidity and mortality rates. Mechanical ventilation, which is commonly used in the management of these critically ill patients, can induce an inflammatory response, which may be involved in distal organ failure. Thus, there may be a complex crosstalk between the lungs and other organs, including the brain. Interestingly, survivors from acute lung injury/acute respiratory distress syndrome frequently have some cognitive deterioration at hospital discharge. Such neurologic dysfunction might be a secondary marker of injury and the neuroanatomical substrate for downstream impairment of other organs. Brainlung interactions have received little attention in the literature, but recent evidence suggests that both the lungs and brain can promote inflammation through common mediators. The present commentary discusses the main physiological issues related to brain-lung interactions.

Figures

Figure 1
Figure 1
Factors affecting the cross-talk between the brain and the lung.

References

    1. Quilez ME, Fuster G, Villar J, Flores C, Martí-Sistac O, Blanch L, López-Aguilar J. Injurious mechanical ventilation affects neuronal activation in ventilated rats. Crit Care. 2011;15:R124. doi: 10.1186/cc10230.
    1. Morandi A, Brummel NE, Ely EW. Sedation, delirium and mechanical ventilation: the 'ABCDE' approach. Curr Opin Crit Care. 2011;17:43–49. doi: 10.1097/MCC.0b013e3283427243.
    1. Heuer JF, Pelosi P, Hermann P, Perske C, Crozier TA, Brück W, Quintel M. Acute effects of intracranial hypertension and ARDS on pulmonary and neuronal damage. A randomized experimental study in pigs. Intensive Care Med. 2011. [Epub ahead of print]
    1. Pelosi P, Ferguson ND, Frutos-Vivar F, Anzueto A, Putensen C, Raymondos K, Apezteguia C, Desmery P, Hurtado J, Abroug F, Elizalde J, Tomicic V, Cakar N, Gonzalez M, Arabi Y, Moreno R, Esteban A. for the Ventila Study Group. Management and outcome of mechanically ventilated neurological patients. Crit Care Med. 2011;39:1482–1492. doi: 10.1097/CCM.0b013e31821209a8.
    1. Gonzalvo R, Martí-Sistac O, Blanch L, López-Aguilar J. Bench-to-bedside review: brain-lung interaction in the critically ill: a pending issue revisited. Crit Care. 2007;11:216. doi: 10.1186/cc5930.
    1. Sanz O, Estrada A, Ferrer I, Planas AM. Differential cellular distribution and dynamics of HSP70, cyclooxygenase-2, and c-Fos in the rat brain after transient focal ischemia or kainic acid. Neuroscience. 1997;80:221–232. doi: 10.1016/S0306-4522(97)00089-4.
    1. Pelosi P, Severgnini P, Chiaranda M. An integrated approach to prevent and treat respiratory failure in brain-injured patients. Curr Opin Crit Care. 2005;11:37–42. doi: 10.1097/00075198-200502000-00006.
    1. Mascia L. Acute lung injury in patients with severe brain injury: a double hit model. Neurocrit Care. 2009;11:417–426. doi: 10.1007/s12028-009-9242-8.
    1. Mascia L, Zavala E, Bosma K, Pasero D, Decaroli D, Andrews P, Isnardi D, Davi A, Arguis MJ, Berardino M, Ducati A. Brain IT group. High tidal volume is associated with the development of acute lung injury after severe brain injury: an international observational study. Crit Care Med. 2007;35:1815–20. doi: 10.1097/01.CCM.0000275269.77467.DF.
    1. Bickenbach J, Zoremba N, Fries M, Dembinski R, Doering R, Ogawa E, Rossaint R, Kuhlen R. Low tidal volume ventilation in a porcine model of acute lung injury improves cerebral tissue oxygenation. Anesth Analg. 2009;109:847–855. doi: 10.1213/ane.0b013e3181ad5769.
    1. Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA, Patel R, Erickson VR, Pittet JF. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma. 2003;55:106–111. doi: 10.1097/.
    1. Hopkins RO, Gale SD, Weaver LK. Brain atrophy and cognitive impairment in survivors of acute respiratory distress syndrome. Brain Inj. 2006;20:263–271. doi: 10.1080/02699050500488199.
    1. Protti A, Cressoni M, Santini A, Langer T, Mietto C, Febres D, Chierichetti M, Coppola S, Conte G, Gatti S, Leopardi O, Masson S, Lombardi L, Lazzerini M, Rampoldi E, Cadringher P, Gattinoni L. Lung stress and strain during mechanical ventilation: any safe threshold? Am J Respir Crit Care Med. 2011;183:1354–1362. doi: 10.1164/rccm.201010-1757OC.
    1. Hughes CG, Pandharipande PP. Review articles: the effects of perioperative and intensive care unit sedation on brain organ dysfunction. Anesth Analg. 2011;112:1212–1217. doi: 10.1213/ANE.0b013e318215366d.
    1. Moriondo A, Marcozzi C, Bianchin F, Passi A, Boschetti F, Lattanzio S, Severgnini P, Pelosi P, Negrini D. Impact of respiratory pattern on lung mechanics and interstitial proteoglycans in spontaneously breathing anaesthetized healthy rats. Acta Physiol (Oxford) 2011. [Epub ahead of print]

Source: PubMed

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