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Pulmonary Manifestations of Neurological Disease

Breathing is a complicated act that requires sophisticated control mechanisms. The nervous system coordinates 3 fundamentally important components of respiration. The central nervous system has a central pattern generator that, along with appropriate feedback mechanisms, establishes both the resiratory rate and the depth of respirations. The peripheral nervous system facilitates transmission of these respiratory commands to the ventilatory muscles. The nervous system also contributes to the control of airway size. Laryngeal function is coordinated with inspiration, and local nerves in the lung have a major role in determining bronchial patency. Finally, the nervous system acts in incompletely understood ways to regulate perfusion of the lungs and to match local pulmonary blood flow with ventilation. Failure of the nervous system to adequately control these 3 different aspects of respiration may result in lifethreatening illness. Understanding how the nervous system affects control of ventilation, airway patency, and pulmonary perfusion therefore will enable intensivists to recognize and manage the pulmonary complications of neurological disease.