Computational Modeling of Primary Blast Lung Injury: Implications for Ventilator Management.
Computational Modeling of Primary Blast Lung Injury: Implications for Ventilator Management.
复制标题
原发性爆炸性肺损伤的计算模型：对呼吸机管理的影响。
DOI：
10.1093/milmed/usy305
复制
发表时间：
2019
影响因子：
1.2
通讯作者：
Kaczka,DavidW
中科院分区：
文献类型：
--
作者：
Herrmann,Jacob;Tawhai,MerrynH;Kaczka,DavidW
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 predictin 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.
