Journal article
Computational Modeling of Primary Blast Lung Injury: Implications for Ventilator Management
Military medicine, Vol.184(Suppl 1), pp.273-281
03/01/2019
DOI: 10.1093/milmed/usy305
PMCID: PMC6515895
PMID: 30901433
Abstract
Primary blast lung injury (PBLI) caused by exposure to high-intensity pressure waves is associated with parenchymal tissue injury and severe ventilation-perfusion mismatch. Although supportive ventilation is often required in patients with PBLI, maldistribution of gas flow in mechanically heterogeneous lungs may lead to further injury due to increased parenchymal strain and strain rate, which are difficult to predict in vivo. In this study, we developed a computational lung model with mechanical properties consistent with healthy and PBLI conditions. PBLI conditions were simulated with bilateral derecruitment and increased perihilar tissue stiffness. As a result of these tissue abnormalities, airway flow was heterogeneously distributed in the model under PBLI conditions, during both conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation. PBLI conditions resulted in over three-fold higher parenchymal strains compared to the healthy condition during CMV, with flow distributed according to regional tissue stiffness. During high-frequency oscillatory ventilation, flow distribution became increasingly heterogeneous and frequency-dependent. We conclude that the distribution and rate of parenchymal distension during mechanical ventilation depend on PBLI severity as well as ventilatory modality. These simulations may allow realistic assessment of the risks associated with ventilator-induced lung injury following PBLI, and facilitate the development of alternative lung-protective ventilation modalities.
Details
- Title: Subtitle
- Computational Modeling of Primary Blast Lung Injury: Implications for Ventilator Management
- Creators
- Jacob Herrmann - Department of Biomedical Engineering, University of Iowa, 5601 Seamans Center for the Engineering Arts and Sciences, Iowa City, IAMerryn H Tawhai - Auckland Bioengineering Institute, University of Auckland, 6/70 Symonds St, Grafton, Auckland 1010, New ZealandDavid W Kaczka - Department of Radiology, University of Iowa Hospitals and Clinics, 3970 John Pappajohn Pavilion, 200 Hawkins Dr, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Military medicine, Vol.184(Suppl 1), pp.273-281
- DOI
- 10.1093/milmed/usy305
- PMID
- 30901433
- PMCID
- PMC6515895
- NLM abbreviation
- Mil Med
- ISSN
- 0026-4075
- eISSN
- 1930-613X
- Publisher
- England
- Grant note
- R01 HL112986 / NHLBI NIH HHS
- Language
- English
- Date published
- 03/01/2019
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Anesthesia
- Record Identifier
- 9984006486402771
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