In a review Zhou et al. published in Neurosurgery clinics of North America the most common pulmonary complications following traumatic brain injury (TBI) and spinal cord injury (SCI) — such as neurogenic pulmonary edema, Acute Respiratory Distress Syndrome, Ventilator-Associated Pneumonia, and thromboembolic events — and summarize current understanding of their pathophysiology and treatment, with the goal of guiding early recognition and management to improve outcomes in neurotrauma patients 3)
🧨 Verdict: ❝A clinically themed PowerPoint stretched into ten pages. No risk. No depth. No new thought.❞
⚠️ Fundamental Flaws No Original Contribution → This is not a review — it’s a recitation. The article contributes zero new data, no expert algorithm, and no provocative insight into managing a leading cause of secondary injury in neurotrauma.
Glosses Over Complexity → Terms like “neurogenic pulmonary edema” and “ARDS” are mentioned, but their nuanced diagnostic dilemmas and overlapping features are avoided. The real challenges are not described — only named.
Management Section = Brochure-Level Medicine → The discussion on treatment reads like an ICU handbook summary. No attention to ICU controversies, no comparison of ventilator strategies (e.g., low PEEP vs. high PEEP in neurotrauma), no mention of prone positioning, recruitment maneuvers, or novel interventions.
No Critical Thinking → The authors seem terrified of taking a stance. There’s no debate, no evaluation of the evidence quality, no suggestions for changing or questioning existing protocols. This could have been written 15 years ago.
Missed Audience → For neurosurgeons, it’s too superficial. For intensivists, it’s insultingly basic. For trainees, it’s uninspiring.
🧪 Scientific Rigor: Low.
No clear methodology for literature selection
No evaluation of guideline discrepancies
No statistical synthesis or rating of evidence quality
🤯 What the Article Should Have Done Provided a decision-making flowchart for pulmonary events in neurotrauma
Compared competing ICU strategies in high ICP vs. low pulmonary compliance scenarios
Addressed controversies (e.g., when to delay tracheostomy in SCI, permissive hypercapnia vs. brain oxygenation)
Proposed a research agenda or hypothesis about pathophysiology (e.g., the sympathetic surge in neurogenic pulmonary edema)
🧠 Final Judgment: Not a review. A placeholder. It fills pages, not gaps in knowledge. The title promises “challenges,” but the text avoids every real one. It’s a missed opportunity from authors who should know better — and a sad sign of what Neurosurg Clin N Am is becoming: safe, sanitized, and forgettable.
Zhou X, Bates AH, Hoffer A. Challenges in Pulmonary Management after Traumatic Brain and Spinal Cord Injury. Neurosurg Clin N Am. 2025 Jul;36(3):355-364. doi: 10.1016/j.nec.2025.03.004. Epub 2025 Apr 28. PMID: 40543944.