Pulmonary and respiratory problems in neurological intensive care patients

Abstract

Neurological intensive care units are centers where diagnoses of patients with lifethreatening neurological pathologies are established and their treatments are provided. There is a close link between the central nervous system and the respiratory system. Respiratory control is fulfilled in the central nervous system, in the medulla oblongata and pons. Respiratory dysrhythmias arise because of various mechanisms, including neurological injury, traumatic brain injury (TBI), bleeding, stroke, and seizures. Depending on neurological lesion levels, pulmonary pathologies such as abnormal breathing patterns, pneumonia, neurogenic pulmonary edema (NPE), acute respiratory distress syndrome (ARDS), and sleep-disordered breathing (SDB) may accompany them. The location of aneurysm rupture bleeding may play a role in the degree of lung dysfunction. Patients with obstructive sleep apnea (OSA) not only have an elevated risk of stroke but also have higher rates of mortality and sequela following stroke. Neurodegenerative diseases that affect the neuromuscular junction (Guillain-Barr' syndrome (GBS), myasthenia gravis (MG), and botulism) may lead to abnormal breathing patterns in the respiratory system. Neurogenic pulmonary edema refers to the increased pulmonary and alveolar interstitial fluid that emerges immediately after a central neurological injury. It has been demonstrated that noninvasive mechanical ventilation (NIMV) is crucial as a first-line treatment in neurological patients since it reduces the need for intubation and facilitates detachment from the mechanical ventilator. As a result, the initial criteria for mechanical ventilation should be individually evaluated for each patient.