Acute and Critical Care

Review Articles

Neurosurgery
Personalized treatment approaches in neurocritical care: Jae Hyun Kim, Chang-Hyun Kim, Hanwool Jeon, Hyun-Chul Jung, Seungjoo Lee; Acute Crit Care. 2026;41(1):33-46. Published online December 8, 2025; DOI: https://doi.org/10.4266/acc.003050

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Abstract PDF: Acute brain injuries—including traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage—exhibit profound pathophysiological heterogeneity, yet are often managed using standardized treatment protocols. While evidence-based guidelines have improved outcomes at a population level, they frequently overlook patient-specific variations in cerebral compliance, autoregulation, and metabolic reserve. This review explores the evolving paradigm of personalized neurocritical care, which integrates dynamic multimodal monitoring, individualized intracranial pressure management strategies, and real-time physiological indices such as pressure reactivity index, cerebral perfusion pressure optimization, and waveform analytics. We highlight the role of noninvasive modalities including quantitative pupillometry, transcranial Doppler, optic nerve sheath diameter ultrasound, near-infrared spectroscopy, and electroencephalography as adjuncts when invasive monitoring is limited or contraindicated. Furthermore, we examine tissue-level monitoring using brain oxygen tension and cerebral microdialysis and emerging blood-based biomarkers such as glial fibrillary acidic protein and neurofilament light. These tools provide granular insight into evolving secondary injury processes. In parallel, advances in artificial intelligence (AI) and machine learning enable deep phenotyping, predictive modeling, and integration of high-dimensional data including imaging, physiology, and omics-based profiles. The development of digital twin models further supports individualized simulation and therapeutic planning. While challenges remain in implementation, data harmonization, and resource availability, the convergence of physiologic monitoring, molecular profiling, and computational modeling offers a transformative pathway toward precision medicine in neurocritical care.

Neurosurgery
Brain-lung interaction: a vicious cycle in traumatic brain injury: Ariana Alejandra Chacón-Aponte, Érika Andrea Durán-Vargas, Jaime Adolfo Arévalo-Carrillo, Iván David Lozada-Martínez, Maria Paz Bolaño-Romero, Luis Rafael Moscote-Salazar, Pedro Grille, Tariq Janjua; Acute Crit Care. 2022;37(1):35-44. Published online February 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01193

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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.

Citations

Citations to this article as recorded by

Recent advances in hydrogel therapy for traumatic brain injury
Zheng Zou, Mengjia Chen, Jun Liu, Huan Ma, Guobiao Liang, Jingyuan Li
Colloids and Surfaces B: Biointerfaces.2026; 260: 115424. CrossRef
A nomogram for predicting the risk of acute respiratory distress syndrome in patients with severe acute brain injury
Qiaoqiao You, Chang Su, Jianping Ye, Miaomiao Chen, JunLong Xu, Xian Zhang, Wen Hu
BMC Neurology.2026;[Epub] CrossRef
The brain-lung axis: bridging neurological and respiratory disorders via neural-immune-microbial dialogue
Wenpei Yang, Xiaoyu Shi, Lizheng Xie, Hao Zhang, Lina Shen, Li Pan, Shi Feng, Xiang Mao, Xiao Wu
Chinese Journal of Traumatology.2026;[Epub] CrossRef
Development and validation of nomogram for predicting neurogenic pulmonary edema in hypertensive intracerebral hemorrhage
Yajuan Xu, Yinxian Shi
Frontiers in Cardiovascular Medicine.2026;[Epub] CrossRef
Structural characteristics of the lungs in experimental inertial traumatic brain injury and endotoxinemia
S. V. Zinoviev, V. B. Shumatov, N. G. Plekhova
Pacific Medical Journal.2026; (4): 5. CrossRef
Prognostic Factors Associated with Pneumonia in Patients with Traumatic Brain Injury: A Systematic Review and Meta-analysis
Talia Mia Bitonti, Kevin M. Durr, Bram Rochwerg, Shannon Fernando, Shane English, Hilary Meggison, Dalibor Kubelik, David Neilipovitz, Scott Millington, Alexis F. Turgeon, Francois Lauzier, Naisan Garraway, Donald E. Griesdale, Paul Engels, Alexandre Tran
Neurocritical Care.2026;[Epub] CrossRef
Analysis of pathogen distribution and sTREM-1 and miR-126 levels in patients with pulmonary infection after craniocerebral injury
Lei Gu, Yun Zhen, Zhenlin Huang, Tianbao Chen, Fuxiong Li, Kaipeng Chen
Technology and Health Care.2025; 33(1): 157. CrossRef
Dynamic pathophysiological features of early primary blast lung injury: a novel functional incapacity pig model
Shifeng Shao, Shasha Wu, Jun Liu, Zhikang Liao, Pengfei Wu, Yuan Yao, Zhen Wang, Liang Zhang, Yaoli Wang, Hui Zhao
European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef
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Nathan K. Evanson, Pratyusha Veldhi, Caitlyn Scherpenberg, John M. Riccobono, Haitham Eid, Jennifer L. McGuire
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Ellen R. Becker, Gregory C. Wetmore, Michael D. Goodman, Dario Rodriquez, Richard D. Branson
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Andrea Duca, Laura Frosio, Luca Molinero, Andrea Finazzi, Ivan Oppedisano, Carlo Bellazzi, Giovanni Nattino, Fabiola Signorini, Guido Bertolini, Eugenia Belotti, Roberto Cosentini
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Directional interactions from non-small cell lung cancer to brain glucose metabolism revealed by total-body PET imaging
Tianzheng Zhong, Yanhua Duan, Kun Li, Jianfeng Qiu, Zhaoping Cheng, Weizhao Lu
European Journal of Nuclear Medicine and Molecular Imaging.2025; 52(12): 4467. CrossRef
Challenges in Pulmonary Management after Traumatic Brain and Spinal Cord Injury
Xiaofei Zhou, Adam Hwan Bates, Alan Hoffer
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Multilevel risk analysis of postoperative pulmonary complications following mandibular fractures: a retrospective cohort study based on patient characteristics and healthcare system factors
Shuwei Liao, Guanxiong Zhu, Liting Zeng, Yang Yu, Zeyu Zhang, Hongru Zhang, Jingyuan Wang, Lina Yu
BMC Oral Health.2025;[Epub] CrossRef
Admission braden scale is an effective marker for predicting pneumonia in critically ill patients with traumatic brain injury
Xuelian Meng, Xia Li, Zhihong Tang
Neurosurgical Review.2025;[Epub] CrossRef
Does pneumonia increase the risk of dementia and cognitive decline? A systematic review and meta-analysis
Zhen Yan, Min Zhang, Lifang Yu, Fulian Zhang
Annals of Medicine.2025;[Epub] CrossRef
Utility of Serum Occludin as a Prognostic Biomarker of Severe Traumatic Brain Injury and Mediation Role of Acute Lung Injury: A Two-Center Prospective Cohort Study
Shaojun Zhang, Xiufeng Ye, Mi Guo, Yidong Jin, Xuebo Zhang, Jiehao Tu, Jing Huang, Zhiqiang Lian, Fangfang You, Han Zhang
International Journal of General Medicine.2025; Volume 18: 3525. CrossRef
Association between traumatic brain injury and risk of developing infections in the central nervous system and periphery
Cristiano Julio Faller, Amanda C. S. Kursancew, Beatriz Brandão Lima, Nicole Golombieski Duarte, Júlia Torcelli Noetzold, Natalli Studnicka, Khiany Mathias, Fabricia Petronilho, Emilio Luiz Streck, Jaqueline S. Generoso
Metabolic Brain Disease.2025;[Epub] CrossRef
Quercetin attenuates acute lung injury after intracerebral hemorrhage in rats via PI3K/AKT/NF-κB-mediated anti-inflammatory mechanisms
Heng Xin, Yong-Hui Lv, Zheng-Ting Qian, Qi-Xian Li, Xiang Li, Yong Tang, Yan Shi, He-Ming Wu
Journal of Radiation Research and Applied Sciences.2025; 18(3): 101732. CrossRef
Predictors of Survival in Patients With Severe Traumatic Brain Injury Undergoing Extracorporeal Membrane Oxygenation
Wardah Rafaqat, Yasmin Arda, Zoha Z. Fazal, May Abiad, Emanuele Lagazzi, Vahe S. Panossian, Ikemsinachi C. Nzenwa, Haytham M.A. Kaafarani, George C. Velmahos, Michael P. DeWane, Benjamin C. Renne
Journal of Surgical Research.2025; 313: 526. CrossRef
Lung-brain axis-generated inflammatory biomarkers in traumatic brain injury and acute respiratory distress syndrome: Role of mechanical ventilation/stress
Nathan H. Johnson, Nancy G. Casanova, Susannah Patarroyo-White, Jason Canizales, Sara M. Camp, Jon Perez Barcena, Juan Pablo de Rivero Vaccari, Bellal Joseph, Joe G.N. Garcia
Advances in Biomarker Sciences and Technology.2025; 7: 238. CrossRef
From Brain to Lung: Emerging Insights into Mesenchymal Stem Cell-Derived Extracellular Vesicle-Associated Cargos in Ischemia-Reperfusion Injury
Yiqing Zhang, Xiaodong Shi, Shuang Li, Shi Yan, Lyu Mei, Yuchen Zou, Chunhua Yan
Journal of Inflammation Research.2025; Volume 18: 11645. CrossRef
Pathophysiology and clinical applications of PEEP in acute brain injury
Ida Giorgia Iavarone, Patricia Rieken Macedo Rocco, Domenico Luca Grieco, Tommaso Rosà, Mariangela Pellegrini, Rafael Badenes, Robert D. Stevens, Karim Asehnoune, Chiara Robba, Luigi Camporota, Antoine Roquilly
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Development and Validation of an Interpretable Machine Learning Model for Predicting venous Thromboembolism in ICU patients With Traumatic Brain Injury: A Multicenter Study
Hao Qi, Lingli Li, Juan Fang, Tianwei Pei, Ao Li, Zhisong Ding, Tao Chen
World Neurosurgery.2025; 202: 124399. CrossRef
Brain Protective Ventilation Strategies in Severe Acute Brain Injury
Sarah Al Sharie, Rahma Almari, Saif Azzam, Lou’i Al-Husinat, Mohammad Araydah, Denise Battaglini, Marcus J. Schultz, Nicolo’ Antonino Patroniti, Patricia RM Rocco, Chiara Robba
Current Neurology and Neuroscience Reports.2025;[Epub] CrossRef
Dynamic nomogram for predicting early tracheotomy in patients diagnosed with supratentorial deep seated intracranial hemorrhage
Chubin Liu, Suqiong Yang, Gang Wang, Jiayin Wang, Liangqin Luo, Yasong Li
Frontiers in Neurology.2025;[Epub] CrossRef
Glymphatic Dysfunction in Neuro-Pulmonary Complications Following Subarachnoid Hemorrhage: A New Perspective on Brain–Lung Axis Disruption
Eun Chae Lee, Jae Sang Oh
Cells.2025; 14(21): 1739. CrossRef
Epidemiology and Outcomes of Battlefield-Related Penetrating and Closed Traumatic Brain Injuries Compared to Non-Head Injuries: A Retrospective Cohort Study
Melissa R Meister, Jason H Boulter, Callum D Dewar, Caren Stuebe, Erica Sercy, M Leigh Carson, Faraz Shaikh, Joseph M Yabes, Laveta Stewart, David R Tribble, Viktor Bartanusz, Bradley Dengler
Military Medicine.2025;[Epub] CrossRef
Early Prediction of Acute Respiratory Distress Syndrome in Critically Ill Polytrauma Patients Using Balanced Random Forest ML: A Retrospective Cohort Study
Nesrine Ben El Hadj Hassine, Sabri Barbaria, Omayma Najah, Halil İbrahim Ceylan, Muhammad Bilal, Lotfi Rebai, Raul Ioan Muntean, Ismail Dergaa, Hanene Boussi Rahmouni
Journal of Clinical Medicine.2025; 14(24): 8934. CrossRef
Uncertainty in Neurocritical Care: Recognizing Its Relevance for Clinical Decision-Making
Luis Rafael Moscote-Salazar, William A. Florez-Perdomo, Tariq Janjua
Indian Journal of Neurotrauma.2024; 21(01): 092. CrossRef
Manejo postoperatorio de resección de tumores cerebrales en la unidad de cuidado intensivo
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Greta Zunino, Denise Battaglini, Daniel Agustin Godoy
Journal of Intensive Medicine.2024; 4(2): 247. CrossRef
Acute brain injury increases pulmonary capillary permeability via sympathetic activation-mediated high fluid shear stress and destruction of the endothelial glycocalyx layer
Na Zhao, Chao Liu, Xinxin Tian, Juan Yang, Tianen Wang
Experimental Cell Research.2024; 434(2): 113873. CrossRef
Oral administration of lysozyme protects against injury of ileum via modulating gut microbiota dysbiosis after severe traumatic brain injury
Weijian Yang, Caihua Xi, Haijun Yao, Qiang Yuan, Jun Zhang, Qifang Chen, Gang Wu, Jin Hu
Frontiers in Cellular and Infection Microbiology.2024;[Epub] CrossRef
Pulmonary Effects of Traumatic Brain Injury in Mice: A Gene Set Enrichment Analysis
Wei-Hung Chan, Shih-Ming Huang, Yi-Lin Chiu
International Journal of Molecular Sciences.2024; 25(5): 3018. CrossRef
Beyond the brain: General intensive care considerations in pediatric neurocritical care
Thao L. Nguyen, Dennis W. Simon, Yi-Chen Lai
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The Impact of Pulmonary Disorders on Neurological Health (Lung-Brain Axis)
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Immune Network.2024;[Epub] CrossRef
Modeling of the brain-lung axis using organoids in traumatic brain injury: an updated review
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ACS Nano.2023; 17(14): 13121. CrossRef
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American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma clinical protocol for management of acute respiratory distress syndrome and severe hypoxemia
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The role of cardiac dysfunction and post-traumatic pulmonary embolism in brain-lung interactions following traumatic brain injury
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Acute and Critical Care.2022; 37(2): 266. CrossRef
Allocation of Donor Lungs in Korea
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Journal of Chest Surgery.2022; 55(4): 274. CrossRef
Mapping brain endophenotypes associated with idiopathic pulmonary fibrosis genetic risk
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eBioMedicine.2022; 86: 104356. CrossRef
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Original Article

Neurology
Continuous heart rate variability and electroencephalography monitoring in severe acute brain injury: a preliminary study: Hyunjo Lee, Sang-Beom Jeon, Kwang-Soo Lee; Acute Crit Care. 2021;36(2):151-161. Published online March 18, 2021; DOI: https://doi.org/10.4266/acc.2020.00703

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172 Download
5 Web of Science
5 Crossref

Abstract PDF

Background
Decreases in heart rate variability have been shown to be associated with poor outcomes in severe acute brain injury. However, it is unknown whether the changes in heart rate variability precede neurological deterioration in such patients. We explored the changes in heart rate variability measured by electrocardiography in patients who had neurological deterioration following severe acute brain injury, and examined the relationship between heart rate variability and electroencephalography parameters.
Methods
Retrospective analysis of 25 patients who manifested neurological deterioration after severe acute brain injury and underwent simultaneous electroencephalography plus electrocardiography monitoring.
Results
Eighteen electroencephalography channels and one simultaneously recorded electrocardiography channel were segmented into epochs of 120-second duration and processed to compute 10 heart rate variability parameters and three quantitative electroencephalography parameters. Raw electroencephalography of the epochs was also assessed by standardized visual interpretation and categorized based on their background abnormalities and ictalinterictal continuum patterns. The heart rate variability and electroencephalography parameters showed consistent changes in the 2-day period before neurological deterioration commenced. Remarkably, the suppression ratio and background abnormality of the electroencephalography parameters had significant reverse correlations with all heart rate variability parameters.
Conclusions
We observed a significantly progressive decline in heart rate variability from the day before the neurological deterioration events in patients with severe acute brain injury were first observed.

Citations

Citations to this article as recorded by

Cross-modal synchronization of EEG and ECG reveals hidden signatures of recovery in traumatic brain injury
Xulong Li, Haibo Teng, Peng Chen, Yuzhe Yuan, Pingchun Li, Mali Song, Jiaxin Yu, Jianguo Xu, Xiangyun Li, Kang Li, Zhiyong Liu
Journal of NeuroEngineering and Rehabilitation.2026;[Epub] CrossRef
Heart Rate Variability Applications in Medical Specialties: A Narrative Review
Jennifer S. Addleman, Nicholas S. Lackey, Molly A. Tobin, Grace A. Lara, Sankalp Sinha, Rebecca M. Morse, Alexander G. Hajduczok, Raouf S. Gharbo, Richard N. Gevirtz
Applied Psychophysiology and Biofeedback.2025; 50(3): 359. CrossRef
Heart Rate Variability and Autonomic Dysfunction After Stroke: Prognostic Markers for Recovery
Sara Lago, Toon T. de Beukelaar, Ilaria Casetta, Giorgio Arcara, Dante Mantini
Biomedicines.2025; 13(7): 1659. CrossRef
Association of Depressive and Somatic Symptoms with Heart Rate Variability in Patients with Traumatic Brain Injury
Seung Don Yoo, Eo Jin Park
Journal of Clinical Medicine.2022; 12(1): 104. CrossRef
Influencing Cardiovascular Outcomes through Heart Rate Variability Modulation: A Systematic Review
Alexandru Burlacu, Crischentian Brinza, Iolanda Valentina Popa, Adrian Covic, Mariana Floria
Diagnostics.2021; 11(12): 2198. CrossRef

Review Article

Neurosurgery
Therapeutic Hypothermia in Traumatic Brain injury; Review of History, Pathophysiology and Current Studies: Do-Keun Kim, Dong-Keun Hyun; Korean J Crit Care Med. 2015;30(3):143-150. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.143

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Abstract PDF: The fact that therapeutic hypothermia (TH) has lowered intracranial pressure and protected brain in severe traumatic brain injury (TBI) is well known throughout past sources and experimental data. In this paper, the result of TH in TBI needs to be confirmed. The result of North American Brain Injury Study; Hypothermia (NAVIS-H) 1 and 2, Eurotherm3235, Japan trauma society study was reviewed throughout randomized controlled study which performed recently. The prognosis was not confirmed throughout TH in NAVIS-H1; however, there was statistical significance among the group of 45 years or less and below 35 degree in celcius which checked when he or she visited initially. Hence, NAVIS-H2 study was preceded. In patient who had surgically removed hematoma, the effects of TH were proved compared to diffuse brain damage in NAVIS-H2 study. This was found in the result of Japan neurotrauma data bank. Eurotherm study has been doing, which leads to collect many data later on. The TBI of TH makes them better prognosis in patients who had surgically removed hematoma and lowered initial body temperature. Later on, it is considered further study is necessary.

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