Mechanical ventilation induces a number of systemic responses for which the brain plays an essential role. During the last decade, substantial evidence has emerged showing that the brain modifies pulmonary responses to physical and biological stimuli by various mechanisms, including the modulation of neuroinflammatory reflexes and the onset of abnormal breathing patterns. Afferent signals and circulating factors from injured peripheral tissues, including the lung, can induce neuronal reprogramming, potentially contributing to neurocognitive dysfunction and psychological alterations seen in critically ill patients. These impairments are ubiquitous in the presence of positive pressure ventilation. This narrative review summarises current evidence of lung–brain crosstalk in patients receiving mechanical ventilation and describes the clinical implications of this crosstalk. Further, it proposes directions for future research ranging from identifying mechanisms of multiorgan failure to mitigating long-term sequelae after critical illness.

机械通气会引起许多全身反应，大脑在这些反应中起着至关重要的作用。在过去十年中，大量证据表明大脑通过各种机制改变肺部对物理和生物刺激的反应，包括调节神经炎症反射和异常呼吸模式的出现。来自受伤外周组织（包括肺）的传入信号和循环因子可诱导神经元重编程，可能导致危重患者的神经认知功能障碍和心理改变。在存在正压通气的情况下，这些损伤无处不在。这篇叙述性综述总结了接受机械通气的患者肺-脑串扰的当前证据，并描述了这种串扰的临床意义。此外，它还提出了未来研究的方向，从确定多器官衰竭的机制到减轻危重病后的长期后遗症。