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

作　　者：Junxian Wen Jia Chen Jianbo Chang Junji Wei 

机构地区：[1]Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Dongcheng District,Beijing 100730,China

出　　处：《Chinese Medical Journal》2022年第7期779-789,共11页中华医学杂志（英文版）

基　　金：National Key Research&Development Program of China(No.2018YFA0108603);the Beijing Tianjin Hebei basic research cooperation project(No.19JCZDJC64600(Z));the CAMS Innovation Fund for Medical Sciences(CIFMS)(No.020-I2M-C&TB-028);the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2020-JKCS-026);the National Natural Science Foundation of China(Nos.81601033,81974183)。

摘　　要：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(V_(t)),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.

关 键 词：Neurocritical care PNEUMONIA Respiratory management Multimodel neuromonitoring TRACHEOSTOMY Mechanical ventilation Positive end-expiratory pressure 

分 类 号：R741[医药卫生—神经病学与精神病学] R563[医药卫生—临床医学]