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Arch Hellen Med, 38(6), November-December 2021, 736-745


The neuropathophysiological approach to neurocognitive impairment
in patients following mechanic ventilation

V. Birba, G. Tsaousi
Department of Anesthesiology and Intensive Care Unit, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

Neurocognitive impairment has a profound impact on the everyday quality of life of patients. A thorough understanding of the mechanisms responsible for such impairment is of paramount importance. Mechanical ventilation (MV) constitutes a vital life support tool for many patients in critical condition, but it incurs a high risk of complications. Patients undergoing MV, even for a short time period, may present neurological deterioration in many cognitive domains, including memory and focusing, and also show deficiency in processing stimuli and executing responses. It is imperative to explore the possible mechanisms and pathways involved in the development of these sequelae. The hippocampal formation is the most common neuropathological site of injury in patients receiving MV. The mechanisms that lead to neurocognitive disturbances related to MV are alveolar overdistension, abnormalities in the partial pressure of oxygen and carbon dioxide, and alterations in the expression of inflammatory mediators, such as cytokines and chemokines. Understanding the pathophysiological pathways will facilitate the development of preventive and therapeutic strategies aimed at improving the neurological outcome of this subset of patients recovering after MV.

Key words: Cognitive disorders, Dopaminergic pathway, Lung-protective mechanic ventilation, Mechanic ventilation, Neurocognitive functions.

© Archives of Hellenic Medicine