Turon Marc, Fernández-Gonzalo Sol, de Haro Candelaria, Magrans Rudys, López-Aguilar Josefina, Blanch Lluís
Critical Care Center, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
CIBERES, Instituto de Salud Carlos III, Madrid, Spain.
Ann Transl Med. 2018 Jan;6(2):30. doi: 10.21037/atm.2017.12.10.
Critical illness may lead to significant long-term neurological morbidity and patients frequently develop neuropsychological disturbances including acute delirium or memory impairment after intensive care unit (ICU) discharge. Mechanical ventilation (MV) is a risk factor to the development of adverse neurocognitive outcomes. Patients undergoing MV for long periods present neurologic impairment with memory and cognitive alteration. Delirium is considered an acute form of brain dysfunction and its prevalence rises in mechanically ventilated patients. Delirium duration is an independent predictor of mortality, ventilation time, ICU length of stay and short- and long-term cognitive impairment in the ICU survivors. Although, neurocognitive sequelae tend to improve after hospital discharge, residual deficits persist even 6 years after ICU stay. ICU-related neurocognitive impairments occurred in many cognitive domains and are particularly pronounced with regard to memory, executive functions, attentional functions, and processing speed. These sequelae have an important impact on patients' lives and ICU survivors often require institutionalization and hospitalization. Experimental studies have served to explore the possible mechanisms or pathways involved in this lung to brain interaction. This communication can be mediated via a complex web of signaling events involving neural, inflammatory, immunologic and neuroendocrine pathways. MV can affect respiratory networks and the application of protective ventilation strategies is mandatory in order to prevent adverse effects. Therefore, strategies focused to minimize lung stretch may improve outcomes, avoiding failure of distal organ, including the brain. Long-term neurocognitive impairments experienced by critically ill survivors may be mitigated by early interventions, combining cognitive and physical therapies. Inpatient rehabilitation interventions in ICU promise to improve outcomes in critically ill patients. The cross-talk between lung and brain, involving specific pathways during critical illness deserves further efforts to evaluate, prevent and improve cognitive alterations after ICU admission, and highlights the crucial importance of tailoring MV to prevent adverse outcomes.
危重病可能导致严重的长期神经功能障碍，患者在重症监护病房（ICU）出院后经常出现神经心理障碍，包括急性谵妄或记忆障碍。机械通气（MV）是不良神经认知结局发生的一个危险因素。长期接受MV的患者会出现神经功能损害，伴有记忆和认知改变。谵妄被认为是脑功能障碍的一种急性形式，在机械通气患者中的发生率会升高。谵妄持续时间是ICU幸存者死亡率、通气时间、ICU住院时间以及短期和长期认知障碍的独立预测因素。尽管神经认知后遗症在出院后往往会有所改善，但即使在ICU住院6年后仍会存在残留缺陷。与ICU相关的神经认知障碍发生在许多认知领域，在记忆、执行功能、注意力功能和处理速度方面尤为明显。这些后遗症对患者的生活有重要影响，ICU幸存者往往需要机构照料和住院治疗。实验研究有助于探索这种肺与脑相互作用中可能涉及的机制或途径。这种交流可以通过涉及神经、炎症、免疫和神经内分泌途径的复杂信号事件网络来介导。MV会影响呼吸网络，因此必须应用保护性通气策略以防止不良影响。因此，旨在尽量减少肺扩张的策略可能会改善结局，避免包括脑在内的远端器官功能衰竭。危重病幸存者经历的长期神经认知障碍可能通过早期干预，结合认知和物理治疗来减轻。ICU中的住院康复干预有望改善危重病患者的结局。肺与脑之间的相互作用，涉及危重病期间的特定途径，值得进一步努力评估、预防和改善ICU入院后的认知改变，并突出了调整MV以预防不良结局的至关重要性。
