Ventilation-associated brain injury

Brain injury may be associated with mechanical ventilation (MV). This thesis explores whether lung-protective MV may lead to brain insult and whether temporary transvenous diaphragm neurostimulation (TTDN) in association with MV mitigates brain injury after 50 hours of MV. Our study used a normal-lung porcine model, comparing apoptotic index, inflammatory markers, and neurological-damage serum markers, between never-ventilated control subjects, subjects undergoing 50 hours of MV plus either TTDN every other breath or every breath, and subjects undergoing 50 hours of MV. Our studies had two important findings. First, lung-protective MV leads to brain injury after 50 hours. Second, TTDN in synchrony with MV mitigates brain injury after 50 hours. Moreover, the neuroprotection observed demonstrated to be dose-dependent with greater protection in the group that had greater exposure to TTDN. The neuroprotection in the group receiving TTDN every breath was characterized by levels of hippocampal apoptosis, hippocampal inflammation, and systemic neurological injury markers similar to those in the NV group.