The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the “blast injury” theory or “double hit” model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury.

End-of-life care is an increasingly relevant topic due to advances in biomedical research and the establishment of new disciplines in evidence-based medicine and bioethics. Euthanasia and assisted suicide are two terms widely discussed in medicine, which cause displeasure on many occasions and cause relief on others. The evolution of these terms and the events associated with their study have allowed the evaluation of cases that have established useful definitions for the legal regulation of palliative care and public policies in the different health systems. However, there are still many aspects to be elucidated and defined. Based on the above, this review aimed to compile relevant historical aspects on the evolution of euthanasia and assisted suicide, which will allow understanding the use and research of these terms.

Flow diverters have become a critical instrument for complex aneurysms treatment. However, limited data are currently available regarding short and long-term outcomes for the Silk flow diverter. The objective of the study is to determine neurological prognosis and mortality rates for the Silk flow diversion device used in intracranial aneurysms. A systematic review with meta-analysis was performed using databases. The following descriptors were used for the search: “SILK”, “Flow Diverter”, “Mortality”, and “Prognosis”. The following data were extracted: mortality, good functional outcome, Glasgow outcome scale, complete or near-complete occlusion rates, rate of retreatment, and complications (thromboembolic and hemorrhagic complications). A total of 14 studies were selected. Among the 14 studies, 13 were retrospective observational cohort studies and 1 was a prospective observational cohort study. The mortality rate was 2.84%. The clinical good outcomes rate was 93.3%. The poor outcome rate was 6.6%. The overall thromboembolic complication rate was 6.06% (95% confidence interval [CI] 0.00–6.37, P=0.12, I2=3.13%). The total hemorrhagic complication rate was 1.62% (95% CI 0.00–5.34, P=0.28, I2=1.56%). The complete aneurysm occlusion rate was 80.4% (95% CI 8.65–9.38, P<0.0001, I2=9.09%). The Silk diverter device has a good safety and efficacy profile for treating intracranial aneurysms with high complete occlusion rates.

Article: Pulmonary injury as a predictor of cerebral hypoxia in traumatic brain injury: from physiology to physiopathology - Journal of Neurosurgical Sciences 2021 Nov 11 - Minerva Medica - Journals

: Introduction: Cerebral vasospasm is the most common factor contributing to morbidity and poor outcome in patients with aneurysmal subarachnoid hemorrhage, second only to rebleeding. Most of current evidence assessed the role of vasodilator effect of the irrigating fluid, and the evidence on effects of cisternal irrigation and clots is currently scarce. Method: According to PRISMA guidelines, determined databases were searched for studies and a meta-analysis was performed. Studies included had to meet the established criteria. The statistical analysis was carried out to obtain relative risk with the Mantel-Haenszel methodology for dichotomous variables. Results: After screening and thorough review, five articles were included for qualitative and quantitative synthesis. (n = 621) participants included in this study with n = 472 for the irrigation group and n = 149 for the non-irrigation group. The mean age of the patients was 59.5 years (age range 27–91 years), with 33.5% male and 66.5% female patients. Cisternal irrigation and clot removal reduce vasospasm (OR 0.46; 95% CI 0.22–0.95) and poor outcome (OR 0.41; 95% CI 0.25–0.65). Conclusions: Irrigation of cisterns and aggressive clot removal is a safe and effective procedure in preventing vasospasm and poor outcome in aSAH patients. No significant differences in hemorrhagic, ischemic, and infectious complications with cisternal irrigation and clot removal were reported. Removal of blood clots increases clot clearance and reduces the risk of the development of post-aneurysmal hydrocephalus. Highlights: