Reappraising traumatic brain injury and ventilator-associated pneumonia through the brain-lung-immune-microbiome axis

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Ventilator-associated pneumonia (VAP) is the most common and deadly infection in patients with severe traumatic brain injury (TBI) on mechanical ventilation.
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The traditional mechanical model of VAP pathogenesis does not fully explain the high incidence of VAP in TBI patients compared to other critically ill populations.
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CNS injury-induced immunodepression syndrome (CIDS) is a key factor in respiratory vulnerability following neurotrauma, driven by immune remodeling and gut microbiota translocation.
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The Brain-Lung-Immune-Microbiome Axis represents a new understanding of the interplay between neurological trauma, immune exhaustion, and microbiome changes.
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Emerging therapies focus on immunomodulation and microbiome-targeted interventions, shifting from mechanical airway hygiene to precision therapeutics in neuro-ICUs.

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