Simon Fraser University, Burnaby, Canada.
Lungpacer Medical Inc, Vancouver, Canada.
Crit Care. 2021 Mar 10;25(1):99. doi: 10.1186/s13054-021-03521-9.
We conducted a systematic review following the PRISMA protocol primarily to identify publications that assessed any links between mechanical ventilation (MV) and either cognitive impairment or brain insult, independent of underlying medical conditions. Secondary objectives were to identify possible gaps in the literature that can be used to inform future studies and move toward a better understanding of this complex problem. The preclinical literature suggests that MV is associated with neuroinflammation, cognitive impairment, and brain insult, reporting higher neuroinflammatory markers, greater evidence of brain injury markers, and lower cognitive scores in subjects that were ventilated longer, compared to those ventilated less, and to never-ventilated subjects. The clinical literature suggests an association between MV and delirium, and that delirium in mechanically ventilated patients may be associated with greater likelihood of long-term cognitive impairment; our systematic review found no clinical study that demonstrated a causal link between MV, cognitive dysfunction, and brain insult. More studies should be designed to investigate ventilation-induced brain injury pathways as well as any causative linkage between MV, cognitive impairment, and brain insult.
我们按照 PRISMA 协议进行了系统评价，主要目的是确定评估机械通气（MV）与认知障碍或脑损伤之间任何关联的出版物，而不考虑潜在的医疗条件。次要目标是确定文献中的可能差距，这些差距可用于为未来的研究提供信息，并更好地了解这一复杂问题。临床前文献表明，MV 与神经炎症、认知障碍和脑损伤有关，报告显示通气时间较长的患者的神经炎症标志物更高，脑损伤标志物的证据更多，认知评分更低，与通气时间较短的患者和从未通气的患者相比。临床文献表明 MV 与谵妄之间存在关联，并且机械通气患者的谵妄可能与长期认知障碍的可能性更大有关；我们的系统评价没有发现临床研究表明 MV、认知功能障碍和脑损伤之间存在因果关系。应设计更多的研究来研究通气引起的脑损伤途径，以及 MV、认知障碍和脑损伤之间的任何因果联系。
