Most patients with ischaemic stroke are managed on the ward or in specialty stroke units, but a significant number requires higher-acuity care and, consequently, admission to the intensive care unit. Mechanical ventilation is frequently performed in these patients due to swallowing dysfunction and airway or respiratory system compromise. Experimental studies have focused on stroke-induced immunosuppression and brain-lung crosstalk, leading to increased pulmonary damage and inflammation, as well as reduced alveolar macrophage phagocytic capability, which may increase the risk of infection. Pulmonary complications, such as respiratory failure, pneumonia, pleural effusions, acute respiratory distress syndrome, lung oedema, and pulmonary embolism from venous thromboembolism, are common and found to be among the major causes of death in this group of patients. Furthermore, over the past two decades, tracheostomy use has increased among stroke patients, who can have unique indications for this procedure—depending on the location and type of stroke—when compared to the general population. However, the optimal mechanical ventilator strategy remains unclear in this population. Although a high tidal volume (VT) strategy has been used for many years, the latest evidence suggests that a protective ventilatory strategy (VT = 6–8 mL/kg predicted body weight, positive end-expiratory pressure and rescue recruitment manoeuvres) may also have a role in brain-damaged patients, including those with stroke. The aim of this narrative review is to explore the pathophysiology of brain-lung interactions after acute ischaemic stroke and the management of mechanical ventilation in these patients.

中文翻译：

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急性缺血性脑卒中患者的机械通气：从病理生理学到临床实践

大多数缺血性卒中患者在病房或专科卒中病房接受治疗，但相当多的患者需要更敏锐的护理，因此需要入住重症监护病房。由于吞咽功能障碍和气道或呼吸系统受损，这些患者经常进行机械通气。实验研究集中在中风引起的免疫抑制和脑-肺串扰，导致肺部损伤和炎症增加，以及肺泡巨噬细胞吞噬能力降低，这可能会增加感染风险。肺部并发症，如呼吸衰竭、肺炎、胸腔积液、急性呼吸窘迫综合征、肺水肿和静脉血栓栓塞引起的肺栓塞，很常见，并被发现是这组患者的主要死因之一。此外，在过去的 20 年中，与普通人群相比，中风患者的气管造口术使用有所增加，根据中风的位置和类型，这些患者可能有独特的适应症。然而，该人群的最佳机械呼吸机策略仍不清楚。尽管高潮气量 (VT) 策略已使用多年，但最新证据表明，保护性通气策略（VT = 6–8 mL/kg 预测体重、呼气末正压和救援招募操作）也可能在脑损伤患者中发挥作用，包括中风患者。