Citation

Nyquist P. Neurocrit. Care 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s12028-024-01943-1

PMID

38413489

Abstract

In ventilated patients in the intensive care unit (ICU), there is a yet uncharacterized subclinical brain injury associated with mechanical ventilation [1,2,3]. At present, no specific clinical or biological model has been definitively identified as a primary underlying cause of brain injury with the use of mechanical ventilation. This is of particular concern in patients with brain injury who are mechanically ventilated and vulnerable to further injury. In this issue of Neurocritical Care, Sanfilippo et al. [4] describe a data intensive prospective observational study examining the effects of recruitment maneuvers (RMs) on various measures of intracranial, cardiac, and pulmonary function. RMs are essential for critical care ventilator management in the ICU and have been hypothesized to cause subclinical brain injury from elevations in intrathoracic pressure and its secondary effects on brain perfusion.

This study is unique in that, for the first time, a direct physiological effect on intracranial pressure and cerebral autoregulation has been demonstrated with the use of RMs. The observed changes support an underlying clinical and biological model implicating a potential cardiopulmonary mechanism as a contributor to subclinical brain injury in mechanically ventilated patients. This is the first study to do so prospectively and systematically while including a wide range of measured cardiac and cerebral physiological parameters. It nicely demonstrates the existence of the relationship between increasing position end expiratory pressure and intrathoracic pressure in RM, with concurrent changes in elevated intracranial pressure, cerebral perfusion pressure, brain autoregulation, and deoxygenation in the brain parenchyma.

Language: en