Focused Management of Patients With Severe Acute Brain Injury and ARDS

Overview

Journal Chest

Publisher Elsevier

Specialty Pulmonary Medicine

Date 2021 Sep 10

PMID 34506794

Citations 10

Authors

Jennifer A Kim

Sarah Wahlster

Jamie Nicole LaBuzetta

Christa Ohana S Nobleza

Nicholas J Johnson

Clio Rubinos

Deepa Malaiyandi

Kristine H OPhelan

Shraddha Mainali

Aarti Sarwal

Emily J Gilmore

Affiliations

Soon will be listed here.

Abstract

Considering the COVID-19 pandemic where concomitant occurrence of ARDS and severe acute brain injury (sABI) has increasingly coemerged, we synthesize existing data regarding the simultaneous management of both conditions. Our aim is to provide readers with fundamental principles and concepts for the management of sABI and ARDS, and highlight challenges and conflicts encountered while managing concurrent disease. Up to 40% of patients with sABI can develop ARDS. Although there are trials and guidelines to support the mainstays of treatment for ARDS and sABI independently, guidance on concomitant management is limited. Treatment strategies aimed at managing severe ARDS may at times conflict with the management of sABI. In this narrative review, we discuss the physiological basis and risks involved during simultaneous management of ARDS and sABI, summarize evidence for treatment decisions, and demonstrate these principles using hypothetical case scenarios. Use of invasive or noninvasive monitoring to assess brain and lung physiology may facilitate goal-directed treatment strategies with the potential to improve outcome. Understanding the pathophysiology and key treatment concepts for comanagement of these conditions is critical to optimizing care in this high-acuity patient population.

Citing Articles

Acute respiratory distress syndrome (ARDS): from mechanistic insights to therapeutic strategies.

Xie R, Tan D, Liu B, Xiao G, Gong F, Zhang Q MedComm (2020). 2025; 6(2):e70074.

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Dimethyl fumarate ameliorates oxidative stress-induced acute kidney injury after traumatic brain injury by activating Keap1-Nrf2/HO-1 signaling pathway.

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Pathophysiology of acute lung injury in patients with acute brain injury: the triple-hit hypothesis.

Ziaka M, Exadaktylos A Crit Care. 2024; 28(1):71.

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