Citation

Herrmann J, Tawhai MH, Kaczka DW. Mil. Med. 2019; 184(Suppl 1): 273-281.

Affiliation

Department of Radiology, University of Iowa Hospitals and Clinics, 3970 John Pappajohn Pavilion, 200 Hawkins Dr, Iowa City, IA.

Copyright

(Copyright © 2019, Association of Military Surgeons of the United States)

DOI

10.1093/milmed/usy305

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.

© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Language: en

Keywords

Computational modeling; High-frequency oscillatory ventilation; Mechanical ventilation; Primary blast lung injury; Respiratory mechanics