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Updated: Aug 13, 2026

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism
Published on: February 14, 2022
Lung-protective ventilation in neurosurgical patients
Gregory J Lowe1, Niall D Ferguson
1Interdepartmental Division of Critical Care Medicine, University Health Network, University of Toronto, Toronto, Canada.
Lung-protective ventilation strategies can be safely applied to most patients with acute brain and lung injuries. Careful management of positive end-expiratory pressure is key to balancing brain and lung protection in this population.
Area of Science:
- Critical Care Medicine
- Neurology
- Pulmonology
Background:
- Ventilator-induced lung injury (VILI) concepts have transformed acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) management.
- Applying lung-protective strategies to patients with acute brain injury presents unique challenges due to differing management goals.
Purpose of the Study:
- To review the safety and efficacy of lung-protective ventilation in patients with concomitant acute brain injury and ALI/ARDS.
- To explore the balance between lung protection and cerebral perfusion in neurocritical care.
Main Methods:
- Review of current literature on mechanical ventilation in patients with ALI/ARDS and acute brain injury.
- Analysis of safety data regarding positive end-expiratory pressure (PEEP) levels in relation to intracranial pressure (ICP).
Main Results:
- Lung-protective strategies are feasible in many patients with acute brain injury and ALI/ARDS.
- Elevated PEEP is often safe in head-injured patients with ALI/ARDS, especially when PEEP < ICP, compliance is low, or lung recruitment occurs.
- Novel VILI therapies for neurosurgical patients are under investigation.
Conclusions:
- Lung protection goals can be met without compromising cerebral perfusion in many brain-injured patients with ALI/ARDS.
- The optimal brain-lung balance remains unclear in patients with refractory intracranial hypertension.
- Further research is essential for refining lung-protective strategies in this vulnerable group.
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