Blood–brain barrier dysfunction in intensive care unit

作     者：Loic Le Guennec Nicolas Weiss Loic Le Guennec;Nicolas Weiss

作者机构：Département de neurologieSorbonne UniversitéAP-HP Sorbonne UniversitéHôpital de la Pitié-SalpêtrièreUnitéde Médecine Intensive Réanimationàorientation neurologiqueParis 75013France Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE(GRC-RESPIRE)Sorbonne UniversitéParis 75013France Brain Liver Pitié-Salpêtrière(BLIPS)Study GroupINSERM UMR_S 938Centre de recherche Saint-AntoineMaladies métaboliquesBiliaires et fibro-inflammatoire du foieInstitute of Cardiometabolism and Nutrition(ICAN)Paris 75013France 

出 版 物：《Journal of Intensive Medicine》 (重症医学（英文）)

年 卷 期：2023年第3卷第4期

页      面：303-312页

核心收录：

学科分类：1002[医学-临床医学] 100205[医学-精神病与精神卫生学] 10[医学] 

基　　金：MedDay Pharmaceuticals 

主　　题：Blood–brain barrier ICU hepatic encephalopathy Delirium Extracorporeal membrane oxygenation(ECMO) Acute bacterial meningitis 

摘      要：The central nervous system is characterized by a peculiar vascularization termed blood–brain barrier(BBB),which regulates the exchange of cells and molecules between the cerebral tissue and the whole body.BBB dysfunction is a life-threatening condition since its presence corresponds to a marker of severity in most diseases encountered in the intensive care unit(ICU).During critical illness,inflammatory response,cytokine release,and other phenomena activating the brain endothelium contribute to alterations in the BBB and increase its permeability to solutes,cells,nutrients,and xenobiotics.Moreover,patients in the ICU are often old,with underlying acute or chronic diseases,and overly medicated due to their critical condition;these factors could also contribute to the development of BBB dysfunction.An accurate diagnostic approach is critical for the identification of the mechanisms underlying BBB alterations,which should be rapidly managed by intensivists.Several methods were developed to investigate the BBB and assess its permeability.Nevertheless,in humans,exploration of the BBB requires the use of indirect methods.Imaging and biochemical methods can be used to study the abnormal passage of molecules through the BBB.In this review,we describe the structural and functional characteristics of the BBB,present tools and methods for probing this interface,and provide examples of the main diseases managed in the ICU that are related to BBB dysfunction.