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The nervous system's role in respiratory failure of patients with COVID-19 is not well-understood and is actively debated. Focusing on this topic, the authors review lung innervation and immunity, particularly the vagus nerve's role and involvement. They suggest considering neurostimulation and pharmacologic neuromodulation to reduce tissue inflammation to prevent respiratory failure. They also propose the concept of a neuroimmune unit, which captures the idea that vagus nerve activity could modulate systemic and local inflammation within the respiratory tract.
As the topic of COVID-19 remains of interest, this article adds to the debate about the best approaches to improve outcomes in patients with the disease.
– Omar Iqbal Khan, MD
This abstract is available on the publisher's site.
COVID-19 is an infectious disease caused by the coronavirus SARS-CoV-2, which was first reported in Wuhan, China, in December 2019 and has caused a global pandemic. Acute respiratory distress syndrome (ARDS) is a common feature of severe forms of COVID-19 and can lead to respiratory failure, especially in older individuals. The increasing recognition of the neurotropic potential of SARS-CoV-2 has sparked interest in the role of the nervous system in respiratory failure in people with COVID-19. However, the neuroimmune interactions in the lung in the context of ARDS are poorly understood. In this Perspectives article, we propose the concept of the neuroimmune unit as a critical determinant of lung function in the context of COVID-19, inflammatory conditions and ageing, focusing particularly on the involvement of the vagus nerve. We discuss approaches such as neurostimulation and pharmacological neuromodulation to reduce tissue inflammation with the aim of preventing respiratory failure.