Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Beijing 100730, China.
Chin Med J (Engl). 2022 Apr 5;135(7):779-789. doi: 10.1097/CM9.0000000000001930.
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 (Vt), 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.
神经重症监护（NCC）不仅通常遵循一般重症监护的原则，还针对特定的目标和方法进行指导。本文综述了影响 NCC 患者的常见肺部疾病和病理生理学，以及在 NCC 中呼吸支持策略方面的进展。本文强调了在神经损伤和呼吸系统疾病之间可能存在的相互作用和途径，包括儿茶酚胺途径、全身炎症反应、肾上腺素能超敏反应和多巴胺能信号传导。神经重症患者的肺部并发症包括肺炎、神经源性肺水肿和呼吸窘迫。呼吸管理的具体方面包括优先保护大脑，呼吸管理的目标是避免不适当的血气成分水平和颅内压升高。与传统的保护性低潮气量（Vt）、高呼气末正压（PEEP）和复张手法的机械通气模式相比，低 PEEP 可能对关闭和保护肺组织有益。多模态神经监测可确保临床和科学实践中呼吸操作的安全性。需要进一步的研究来制定 NCC 呼吸管理指南。
