Crosstalk between brain, lung and heart in critical care - 04/08/20

Doi : 10.1016/j.accpm.2020.06.016

Ségolène Mrozek ^a,⁎ , Julie Gobin ^a, Jean-Michel Constantin ^b, Olivier Fourcade ^a, Thomas Geeraerts ^a
^a Department of anaesthesia and critical care, university hospital of Toulouse, university Toulouse 3 Paul Sabatier, Toulouse, France
^b Department of anaesthesia and critical care, Sorbonne university, La Pitié-Salpêtrière hospital, Assistance publique–Hôpitaux de Paris, Paris, France

^⁎Corresponding author. Coordination d’anesthésie, hôpital Pierre-Paul-Riquet, CHU Toulouse, 31059 Toulouse, France.Coordination d’anesthésie, hôpital Pierre-Paul-Riquet, CHU ToulouseToulouse31059France

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Abstract

Extracerebral complications, especially pulmonary and cardiovascular, are frequent in brain-injured patients and are major outcome determinants. Two major pathways have been described: brain-lung and brain-heart interactions. Lung injuries after acute brain damages include ventilator-associated pneumonia (VAP), acute respiratory distress syndrome (ARDS) and neurogenic pulmonary œdema (NPE), whereas heart injuries can range from cardiac enzymes release, ECG abnormalities to left ventricle dysfunction or cardiogenic shock. The pathophysiologies of these brain-lung and brain-heart crosstalk are complex and sometimes interconnected. This review aims to describe the epidemiology and pathophysiology of lung and heart injuries in brain-injured patients with the different pathways implicated and the clinical implications for critical care physicians.

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Keywords : Acute respiratory distress syndrome, Brain injury, Brain-lung crosstalk, Brain-heart crosstalk, Cardiomyopathy, Neurogenic pulmonary œdema