Mechanical ventilation and neurocritical patients: is there a role for anti-neuroinflammatory therapies?

Authors’ response Battaglini D; Bonatti G; Robba C; Rocco PRM; Pelosi P Dear Editor, We thank Professor Bilotta and colleagues for their interest in our recent scientific contribution [1]. The authors pointed out the role of neuroinflammation due to mechanical ventilation in stroke, thus advising the relevance of possible novel pharmacological strategies. First, we were asked to clarify our point of view regarding the existence of significant neuroinflammation induced by mechanical ventilation in stroke, as challenged by Hegeman and colleagues [4]. We fully agree with the importance of neuroinflammation due to mechanical ventilation in stroke patients, and in our review, discussed only few of those papers referring to neuromodulation in stroke. Different perspectives have been reported in the literature, which focus on the complex interaction among the neuroendocrine, neuroinflammatory, autonomic and immunologic pathways, both implicated in lung injury that can affect the brain [6]. Furthermore, different neuromodulation patterns, as well as different brain-lung interactions, may occur due to mechanical ventilation or primary cerebral pathologies. Second, as suggested, novel anti-inflammatory therapies for modulating the neuroinflammatory response (such as lidocaine) could play a role in the near future. This is another interesting issue that we did not take into consideration in our review, which focused on mechanical ventilation strategies in stroke. Experimental and clinical perspectives suggest a wide range of promising therapies against neuroinflammation in stroke, including molecular modulation, such as those reported by the use of minocycline in rats [7] or by modulating the vagal and dopaminergic pathways [8]. Newer biomolecular targets, such as noradrenergic and dopaminergic receptors, stem cell therapy, microRNA, and interleukins, all of which are still in the preclinical stages of research, are also of the utmost interest. However, addressing these would have exceeded the scope of our study.