Cerebral Effects of Oxygen and Carbon Dioxide in Acute Respiratory Distress Syndrome
Keywords:
human ARDS, COVID-19, stroke, mechanic ventilation, intracranial hypertension, hypoxemia, CO2.Abstract
Introduction: The acute respiratory distress syndrome produced by COVID-19 causes alterations in the exchange of oxygen and the excretion of carbon dioxide with neurological consequences.
Objective: To describe the implications of oxygen and carbon dioxide on brain dynamics during ventilatory treatment of acute respiratory distress syndrome in stroke.
Methods: A search was carried out in referential bases such as PubMed/Medline, SciELO, Google Scholar and VHL Cuba. The terms included were brain-lung crosstalk, ARDS, mechanical ventilation, COVID-19 related stroke, ARDS related stroke and their translation into Spanish. Books on neurointensive care and artificial mechanical ventilation were referenced. The search period included the last 20 years. Forty six bibliographies that met the selection criteria were selected.
Results: Oxygen and carbon dioxide levels have been described to participate in vascular neuroregulation in patients with brain damage. Some allusive alterations are reflex cerebral vasodilatation or vasoconstrictor effects with reduced cerebral perfusion pressure. As a consequence, intracranial pressure increases and neurocognitive impairments, delayed cerebral ischemia or brainstem herniation appear.
Conclusions: The control of oxygenation and the excretion of carbon dioxide were crucial to maintain neuronal homeostasis, avoiding the decrease in cerebral perfusion pressure and the increase in intracranial pressure. It is suggested to avoid hypoxemia and hyperoxemia, limit or avoid hypercapnia, and use hypocapnic hyperventilation only in conditions of brainstem herniation.
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