A model of blast overpressure injury to the lung

Human lung simulants subjected to underwater explosions - An experimental investigation

An experimental investigation was performed on human lung simulants to evaluate their response to an underwater explosive blast. The artificial lungs were instrumented with sensors to record changes in the internal pressure and strains for a specimen with and without a surrounding ribcage. The lungs were to-scale models representative of a 50th-percentile male. The experiments were performed using 65.5 mg of explosive charge placed 0.5 m from the lungs in an 8,200-liter water tank. The tank was instrumented with blast transducers and high-speed cameras to measure the pressure from the explosive charge and record the lung deformation history through high-speed images and digital image correlation. Results showed a significantly delayed response to the underwater blast due to the lungs' inertia. In addition, the lung response was indifferent to its orientation relative to the shock direction. The lungs initially contracted after the underwater shock and then expanded, showing a 50% change in relative volume, from minimum to maximum volume, over a 7 ms duration. Results and observations qualitatively relate to the types of injuries observed during preexisting case studies.

A New Anthropomorphic Mannequin for Efficacy Evaluation of Thoracic Protective Equipment Against Blast Threats

Exposure to blast is one of the major causes of death and disability in recent military conflicts. Therefore, it is crucial to evaluate the protective capability of the ballistic-proof equipment worn by soldiers against the effects of blast overpressure (i.e., primary blast injuries). A focus will be made on thoracic protective equipment (TPE). An anthropomorphic mannequin, called BOPMAN, and anesthetized swine both wearing soft, hard or no ballistic protection, were subjected to an open-field high-intensity blast. For swine, thoracic wall motion (acceleration and velocity) was recorded during blast exposure and severity of lung injury was evaluated postmortem. Different data were collected from BOPMAN thoracic responses, including reflected and internal pressure, as well as the force at the rear face of the instrumented part. The severity of blast-induced lung injuries (contusion extent, Axelsson Severity Scale) and the thoracic wall motion were decreased in animals protected with thoracic ceramic hard plates as compared to those wearing soft or no protection. There was a clear trend towards greater lung injury in animals protected with the soft body armor used, even when compared to unprotected animals. In line with these experimental data, the measured force as well as the force impulse measured using BOPMAN were also decreased with a ceramic hard plate protection and increased when a soft ballistic pack was used compared to no protection. Comparison of data collected on BOPMAN and swine equipped with the same protection level revealed that those two force parameters were well correlated with the level of blast-induced lung injury (force, R² = 0.74 and force impulse, R² = 0.77, p < 0.05). Taken together, our results suggest that the force and the force impulse data from BOPMAN may help estimate the efficiency of existing TPE regarding lung protection under blast exposure and may represent an important tool for development of future TPE.

Biomechanically Based Correlate for Localized Lung Contusion From Nonlethal Blunt Impact Projectiles

INTRODUCTION

Injury mechanics of blunt impact projectiles differ from those experienced in whole body motor vehicle collisions because the effects are localized around the point of impact, and thus, injury thresholds based upon gross chest kinematics (e.g., force, velocity) may not be applicable across impact types. Therefore, knowledge of biomechanically based tissue injury correlates for blunt impact projectiles are needed to better guide design and development of protective systems as well as assess injury risks from blunt impact projectile weapons.

MATERIALS AND METHODS

In this study, subject-specific swine finite element models were used to quantify the tissue-level stresses and strains resulting from high speed projectile impact. These tissue-level injury doses were correlated to pathology injury outcomes to produce injury risk curves for lung contusion. Details of the pathology data and finite element results are provided in Appendix 1. Survival analysis regression methods were applied to develop lung injury regression curves and a number of statistical methods were used to evaluate several biomechanical metrics as correlates to lung contusion. Uncertainty and sensitivity analyses were used to further confirm the selection of the correlate.

RESULTS

Statistical analysis revealed that normalized strain-energy density was the best correlate for prediction of lung tissue damage. Going further, normalized strain-energy density also proved to be suitable for prediction of the percentage of contused lung volume, a more meaningful medical diagnosis. As expected, peak strain-energy density is most sensitive to muscle-skin properties, as quantified through a comprehensive uncertainty and sensitivity analysis over three sets of projectile weights and speeds.

CONCLUSIONS

Normalized strain-energy density was found to be the best correlate for prediction of lung tissue damage and correlate well to extent of contused lung volume.

On models of blast overpressure effects to the thorax

Shock waves from explosions can cause lethal injuries to humans. Current state-of the-art models for pressure induced lung injuries were typically empirically derived and are only valid for detonations in free-field conditions. In built-up environments, though, pressure–time histories differ significantly from this idealization and not all explosions exhibit detonation characteristics. Hence, those approaches cannot be deployed. However, the actual correlation between dynamic shock wave characteristics and gradual degree of injury have yet to be fully described. In an attempt to characterize the physical response of the human body to complex shock-wave effects, viscoelastic models were developed in the past (Axelsson and Yelverton, in J Trauma Acute Care Surg 40, 31S–37S, 1996; Stuhmiller et al., in J Biomech. 10.1016/0021-9290(95)00039-9, 1996). We discuss those existing modeling approaches especially in view of their viscoelastic behavior and point out drawbacks regarding their response to standard stimuli. Further, we suggest to fully acknowledge the experimentally anticipated viscoelastic behavior of the effective thorax models by using a newly formulated standard model for viscoelastic solids instead of damped harmonic oscillators. Concerning injury assessment, we discuss the individual injury criteria proposed along with existing models pointing out desirable improvements with respect to complex blast situations, e.g. the necessity to account for repeated exposure (criteria with time-memory), and further adaption with respect to nonlinear gas dynamics inside the lung. Finally, we present an improved modeling approach for complex blast overpressure effects to the thorax with few parameters that is more suitable for the characteristics of complex blast wave propagation than other current models.

Pulmonary injury risk curves and behavioral changes from blast overpressure exposures of varying frequency and intensity in rats

At present, there are no set guidelines establishing cumulative limits for blast exposure numbers and intensities in military personnel, in combat or training operations. The objective of the current study was to define lung injury, pathology, and associated behavioral changes from primary repeated blast lung injury under appropriate exposure conditions and combinations (i.e. blast overpressure (BOP) intensity and exposure frequency) using an advanced blast simulator. Male Sprague Dawley rats were exposed to BOP frontally and laterally at a pressure range of ~ 8.5-19 psi, for up to 30 daily exposures. The extent of lung injury was identified at 24 h following BOP by assessing the extent of surface hemorrhage/contusion, Hematoxylin and Eosin staining, and behavioral deficits with open field activity. Lung injury was mathematically modeled to define the military standard 1% lung injury threshold. Significant levels of histiocytosis and inflammation were observed in pressures ≥ 10 psi and orientation effects were observed at pressures ≥ 13 psi. Experimental data demonstrated ~ 8.5 psi is the threshold for hemorrhage/contusion, up to 30 exposures. Modeling the data predicted injury risk up to 50 exposures with intensity thresholds at 8 psi for front exposure and 6psi for side exposures, which needs to be validated further.

Modeling lung tissue dynamics and injury under pressure and impact loading

A nonlinear viscoelastic model for the lung is implemented and evaluated for high-rate loading. Principal features of the model include a closed-cell approximation of the bulk compressibility accounting for air inside the lung and a damage-injury component by which local trauma is induced by cumulative normalized internal energy and amplified by gradients of energy density. The latter feature is adapted for use in standard numerical (i.e., explicit finite element) simulations in terms of the local rate of strain energy density and the longitudinal wave speed. Injury predictions for direct loading of a block of extracted lung material, rather than the entire thorax, via pressure pulses are in reasonably close agreement with experimental observations for an extracted rabbit lung: a threshold applied pressure exists above which edema is observed experimentally, correlating with low but non-negligible damage in the numerical results. Responses to impact by cylindrical and spherical projectiles are also interrogated. Penetration depths are comparable to those observed experimentally, as is drastically increasing damage with increasing impact velocity. Damage initiates and propagates from the impact surface, with local severity of injury decreasing with distance from the impact zone, in agreement with some empirical evidence. The model predicts more severe local injury, relative to the aforementioned surface pressure loading, than what is observed experimentally. Possible reasons for the discrepancy are analyzed, and adjustments to the model, with caveats, are suggested accordingly.

Computational Modeling of Primary Blast Lung Injury: Implications for Ventilator Management

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.

Do blast induced skull flexures result in axonal deformation?

Subject-specific computer models (male and female) of the human head were used to investigate the possible axonal deformation resulting from the primary phase blast-induced skull flexures. The corresponding axonal tractography was explicitly incorporated into these finite element models using a recently developed technique based on the embedded finite element method. These models were subjected to extensive verification against experimental studies which examined their pressure and displacement response under a wide range of loading conditions. Once verified, a parametric study was developed to investigate the axonal deformation for a wide range of loading overpressures and directions as well as varying cerebrospinal fluid (CSF) material models. This study focuses on early times during a blast event, just as the shock transverses the skull (< 5 milliseconds). Corresponding boundary conditions were applied to eliminate the rotation effects and the resulting axonal deformation. A total of 138 simulations were developed– 128 simulations for studying the different loading scenarios and 10 simulations for studying the effects of CSF material model variance–leading to a total of 10,702 simulation core hours. Extreme strains and strain rates along each of the fiber tracts in each of these scenarios were documented and presented here. The results suggest that the blast-induced skull flexures result in strain rates as high as 150–378 s^-1. These high-strain rates of the axonal fiber tracts, caused by flexural displacement of the skull, could lead to a rate dependent micro-structural axonal damage, as pointed by other researchers.

Computational modeling of blast induced whole-body injury: a review

Blast injuries affect millions of lives across the globe due to its traumatic after effects on the brain and the whole body. To date, military grade armour materials are designed to mitigate ballistic and shrapnel attacks but are less effective in resisting blast impacts. In order to improve blast absorption characteristics of armours, the first key step is thoroughly understands the effects of blasts on the human body itself. In the last decade, a plethora of experimental and computational work has been carried out to investigate the mechanics and pathophysiology of Traumatic Brain Injury (TBI). However, very few attempts have been made so far to study the effect of blasts on the various other parts of the body such as the sensory organs (eyes and ears), nervous system, thorax, extremities, internal organs (such as the lungs) and the skeletal system. While an experimental evaluation of blast effects on such physiological systems is difficult, developing finite element (FE) models could allow the recreation of realistic blast scenarios on full scale human models and simulate the effects. The current article reviews the state-of-the-art in computational research in blast induced whole-body injury modelling, which would not only help in identifying the areas in which further research is required, but would also be indispensable for understanding body location specific armour design criteria for improved blast injury mitigation.

A critical literature review on primary blast thorax injury and their outcomes

Since World War II, researchers have been interested in exploring the injury mechanisms involved in primary blast on the thorax by using animal model surrogates. These studies were mostly concerned with the finding of the lung injury threshold, the relationship between the physical components of the air blast wave, and the biological response. Studies have also been conducted to investigate the effect of repeated blast exposures on the injury outcome threshold. This has led to several injury criteria, such as the Bowen curves based on pressure history's characteristics or the Axelsson Chest Wall Velocity Predictor that used measurement from the mammals' chest wall. This article aims at doing a critical literature review of this specific topic.

Primary blast causes mild, moderate, severe and lethal TBI with increasing blast overpressures: Experimental rat injury model

Injury severity in blast induced Traumatic Brain Injury (bTBI) increases with blast overpressure (BOP) and impulse in dose-dependent manner. Pure primary blast waves were simulated in compressed gas shock-tubes in discrete increments. Present work demonstrates 24 hour survival of rats in 0–450 kPa (0–800 Pa∙s impulse) range at 10 discrete levels (60, 100, 130, 160, 190, 230, 250, 290, 350 and 420 kPa) and determines the mortality rate as a non-linear function of BOP. Using logistic regression model, predicted mortality rate (PMR) function was calculated, and used to establish TBI severities. We determined a BOP of 145 kPa as upper mild TBI threshold (5% PMR). Also we determined 146–220 kPa and 221–290 kPa levels as moderate and severe TBI based on 35%, and 70% PMR, respectively, while BOP above 290 kPa is lethal. Since there are no standards for animal bTBI injury severity, these thresholds need further refinements using histopathology, immunohistochemistry and behavior. Further, we specifically investigated mild TBI range (0–145 kPa) using physiological (heart rate), pathological (lung injury), immuno-histochemical (oxidative/nitrosative and blood-brain barrier markers) as well as blood borne biomarkers. With these additional data, we conclude that mild bTBI occurs in rats when the BOP is in the range of 85–145 kPa.

From military to civil loadings: Preliminary numerical-based thorax injury criteria investigations

Effects of the impact of a mechanical structure on the human body are of great interest in the understanding of body trauma. Experimental tests have led to first conclusions about the dangerousness of an impact observing impact forces or displacement time history with PMHS (Post Mortem human Subjects). They have allowed providing interesting data for the development and the validation of numerical biomechanical models. These models, widely used in the framework of automotive crashworthiness, have led to the development of numerical-based injury criteria and tolerance thresholds. The aim of this process is to improve the safety of mechanical structures in interaction with the body. In a military context, investigations both at experimental and numerical level are less successfully completed. For both military and civil frameworks, the literature list a number of numerical analysis trying to propose injury mechanisms, and tolerance thresholds based on biofidelic Finite Element (FE) models of different part of the human body. However the link between both frameworks is not obvious, since lots of parameters are different: great mass impacts at relatively low velocity for civil impacts (falls, automotive crashworthiness) and low mass at very high velocity for military loadings (ballistic, blast). In this study, different accident cases were investigated, and replicated with a previously developed and validated FE model of the human thorax named Hermaphrodite Universal Biomechanical YX model (HUBYX model). These previous validations included replications of standard experimental tests often used to validate models in the context of automotive industry, experimental ballistic tests in high speed dynamic impact and also numerical replication of blast loading test ensuring its biofidelity. In order to extend the use of this model in other frameworks, some real-world accidents were reconstructed, and consequences of these loadings on the FE model were explored. These various numerical replications of accident coming from different contexts raise the question about the ability of a FE model to correctly predict several kinds of trauma, from blast or ballistic impacts to falls, sports or automotive ones in a context of numerical injury mechanisms and tolerance limits investigations.

Experimental Evidence of Mechanical Isotropy in Porcine Lung Parenchyma

Pulmonary injuries are a major source of morbidity and mortality associated with trauma. Trauma includes injuries associated with accidents and falls as well as blast injuries caused by explosives. The prevalence and mortality of these injuries has made research of pulmonary injury a major priority. Lungs have a complex structure, with multiple types of tissues necessary to allow successful respiration. The soft, porous parenchyma is the component of the lung which contains the alveoli responsible for gas exchange. Parenchyma is also the portion which is most susceptible to traumatic injury. Finite element simulations are an important tool for studying traumatic injury to the human body. These simulations rely on material properties to accurately recreate real world mechanical behaviors. Previous studies have explored the mechanical properties of lung tissues, specifically parenchyma. These studies have assumed material isotropy but, to our knowledge, no study has thoroughly tested and quantified this assumption. This study presents a novel methodology for assessing isotropy in a tissue, and applies these methods to porcine lung parenchyma. Briefly, lung parenchyma samples were dissected so as to be aligned with one of the three anatomical planes, sagittal, frontal, and transverse, and then subjected to compressive mechanical testing. Stress-strain curves from these tests were statistically compared by a novel method for differences in stresses and strains at percentages of the curve. Histological samples aligned with the anatomical planes were also examined by qualitative and quantitative methods to determine any differences in the microstructural morphology. Our study showed significant evidence to support the hypothesis that lung parenchyma behaves isotropically.

A critical review of anaesthetised animal models and alternatives for military research, testing and training, with a focus on blast damage, haemorrhage and resuscitation

Military research, testing, and surgical and resuscitation training, are aimed at mitigating the consequences of warfare and terrorism to armed forces and civilians. Traumatisation and tissue damage due to explosions, and acute loss of blood due to haemorrhage, remain crucial, potentially preventable, causes of battlefield casualties and mortalities. There is also the additional threat from inhalation of chemical and aerosolised biological weapons. The use of anaesthetised animal models, and their respective replacement alternatives, for military purposes -- particularly for blast injury, haemorrhaging and resuscitation training -- is critically reviewed. Scientific problems with the animal models include the use of crude, uncontrolled and non-standardised methods for traumatisation, an inability to model all key trauma mechanisms, and complex modulating effects of general anaesthesia on target organ physiology. Such effects depend on the anaesthetic and influence the cardiovascular system, respiration, breathing, cerebral haemodynamics, neuroprotection, and the integrity of the blood-brain barrier. Some anaesthetics also bind to the NMDA brain receptor with possible differential consequences in control and anaesthetised animals. There is also some evidence for gender-specific effects. Despite the fact that these issues are widely known, there is little published information on their potential, at best, to complicate data interpretation and, at worst, to invalidate animal models. There is also a paucity of detail on the anaesthesiology used in studies, and this can hinder correct data evaluation. Welfare issues relate mainly to the possibility of acute pain as a side-effect of traumatisation in recovered animals. Moreover, there is the increased potential for animals to suffer when anaesthesia is temporary, and the procedures invasive. These dilemmas can be addressed, however, as a diverse range of replacement approaches exist, including computer and mathematical dynamic modelling of the human body, cadavers, interactive human patient simulators for training, in vitro techniques involving organotypic cultures of target organs, and epidemiological and clinical studies. While the first four of these have long proven useful for developing protective measures and predicting the consequences of trauma, and although many phenomena and their sequelae arising from different forms of trauma in vivo can be induced and reproduced in vitro, non-animal approaches require further development, and their validation and use need to be coordinated and harmonised. Recommendations to these ends are proposed, and the scientific and welfare problems associated with animal models are addressed, with the future focus being on the use of batteries of complementary replacement methods deployed in integrated strategies, and on greater transparency and scientific cooperation.

Neuro-glial and systemic mechanisms of pathological responses in rat models of primary blast overpressure compared to "composite" blast

A number of experimental models of blast brain injury have been implemented in rodents and larger animals. However, the variety of blast sources and the complexity of blast wave biophysics have made data on injury mechanisms and biomarkers difficult to analyze and compare. Recently, we showed the importance of rat position toward blast generated by an external shock tube. In this study, we further characterized blast producing moderate traumatic brain injury and defined "composite" blast and primary blast exposure set-ups. Schlieren optics visualized interaction between the head and a shock wave generated by external shock tube, revealing strong head acceleration upon positioning the rat on-axis with the shock tube (composite blast), but negligible skull movement upon peak overpressure exposure off-axis (primary blast). Brain injury signatures of a primary blast hitting the frontal head were assessed and compared to damage produced by composite blast. Low to negligible levels of neurodegeneration were found following primary blast compared to composite blast by silver staining. However, persistent gliosis in hippocampus and accumulation of GFAP/CNPase in circulation was detected after both primary and composite blast. Also, markers of vascular/endothelial inflammation integrin alpha/beta, soluble intercellular adhesion molecule-1, and L-selectin along with neurotrophic factor nerve growth factor-beta were increased in serum within 6 h post-blasts and persisted for 7 days thereafter. In contrast, systemic IL-1, IL-10, fractalkine, neuroendocrine peptide Orexin A, and VEGF receptor Neuropilin-2 (NRP-2) were raised predominantly after primary blast exposure. In conclusion, biomarkers of major pathological pathways were elevated at all blast set-ups. The most significant and persistent changes in neuro-glial markers were found after composite blast, while primary blast instigated prominent systemic cytokine/chemokine, Orexin A, and Neuropilin-2 release, particularly when primary blast impacted rats with unprotected body.

Skull flexure as a contributing factor in the mechanism of injury in the rat when exposed to a shock wave

The manner in which energy from an explosion is transmitted into the brain is currently a highly debated topic within the blast injury community. This study was conducted to investigate the injury biomechanics causing blast-related neurotrauma in the rat. Biomechanical responses of the rat head under shock wave loading were measured using strain gauges on the skull surface and a fiber optic pressure sensor placed within the cortex. MicroCT imaging techniques were applied to quantify skull bone thickness. The strain gauge results indicated that the response of the rat skull is dependent on the intensity of the incident shock wave; greater intensity shock waves cause greater deflections of the skull. The intracranial pressure (ICP) sensors indicated that the peak pressure developed within the brain was greater than the peak side-on external pressure and correlated with surface strain. The bone plates between the lambda, bregma, and midline sutures are probable regions for the greatest flexure to occur. The data provides evidence that skull flexure is a likely candidate for the development of ICP gradients within the rat brain. This dependency of transmitted stress on particular skull dynamics for a given species should be considered by those investigating blast-related neurotrauma using animal models.

Mechanisms of primary blast-induced traumatic brain injury: insights from shock-wave research

Traumatic brain injury caused by explosive or blast events is traditionally divided into four phases: primary, secondary, tertiary, and quaternary blast injury. These phases of blast-induced traumatic brain injury (bTBI) are biomechanically distinct and can be modeled in both in vivo and in vitro systems. The primary bTBI injury phase represents the response of brain tissue to the initial blast wave. Among the four phases of bTBI, there is a remarkable paucity of information about the cause of primary bTBI. On the other hand, 30 years of research on the medical application of shockwaves (SW) has given us insight into the mechanisms of tissue and cellular damage in bTBI, including both air-mediated and underwater SW sources. From a basic physics perspective, the typical blast wave consists of a lead SW followed by supersonic flow. The resultant tissue injury includes several features observed in bTBI, such as hemorrhage, edema, pseudoaneurysm formation, vasoconstriction, and induction of apoptosis. These are well-described pathological findings within the SW literature. Acoustic impedance mismatch, penetration of tissue by shock/bubble interaction, geometry of the skull, shear stress, tensile stress, and subsequent cavitation formation, are all important factors in determining the extent of SW-induced tissue and cellular injury. Herein we describe the requirements for the adequate experimental set-up when investigating blast-induced tissue and cellular injury; review SW physics, research, and the importance of engineering validation (visualization/pressure measurement/numerical simulation); and, based upon our findings of SW-induced injury, discuss the potential underlying mechanisms of primary bTBI.

Biomarkers of blast-induced neurotrauma: profiling molecular and cellular mechanisms of blast brain injury

The nature of warfare in the 21st century has led to a significant increase in primary blast or over-pressurization injuries to the whole body and head, which manifest as a complex of neuro-somatic damage, including traumatic brain injury (TBI). Identifying relevant pathogenic pathways in reproducible experimental models of primary blast wave exposure is therefore vital to the development of biomarkers for diagnostics of blast brain injury. Comparative analysis of mechanisms and putative biomarkers of blast brain injury is complicated by a deficiency of experimental studies. In this article, we present an overview of current TBI biomarkers, as well as outline experimental strategies to investigate molecular signatures of blast neurotrauma and to develop a pathway network map for novel biomarker discovery. These biomarkers will be effective for triaging and managing both combat and civilian casualities.

The effects of anthropogenic sources of sound on fishes

There is increasing concern about the effects of pile driving and other anthropogenic (human-generated) sound on fishes. Although there is a growing body of reports examining this issue, little of the work is found in the peer-reviewed literature. This review critically examines both the peer-reviewed and 'grey' literature, with the goal of determining what is known and not known about effects on fish. A companion piece provides an analysis of the available data and applies it to estimate noise exposure criteria for pile driving and other impulsive sounds. The critical literature review concludes that very little is known about effects of pile driving and other anthropogenic sounds on fishes, and that it is not yet possible to extrapolate from one experiment to other signal parameters of the same sound, to other types of sounds, to other effects, or to other species.

Blast Lung Injury

Current trends in global terrorism mandate that emergency medical services, emergency medicine and other acute care clinicians have a basic understanding of the physics of explosions, the types of injuries that can result from an explosion, and current management for patients injured by explosions. High-order explosive detonations result in near instantaneous transformation of the explosive material into a highly pressurized gas, releasing energy at supersonic speeds. This results in the formation of a blast wave that travels out from the epicenter of the blast. Primary blast injuries are characterized by anatomical and physiological changes from the force generated by the blast wave impacting the body's surface, and affect primarily gas-containing structures (lungs, gastrointestinal tract, ears). "Blast lung" is a clinical diagnosis and is characterized as respiratory difficulty and hypoxia without obvious external injury to the chest. It may be complicated by pneumothoraces and air emboli and may be associated with multiple other injuries. Patients may present with a variety of symptoms, including dyspnea, chest pain, cough, and hemoptysis. Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. Chest radiography, computerized tomography, and arterial blood gases may assist with diagnosis and management; however, they should not delay diagnosis and emergency interventions in the patient exposed to a blast. High flow oxygen, airway management, tube thoracostomy in the setting of pneumothoraces, mechanical ventilation (when required) with permissive hypercapnia, and judicious fluid administration are essential components in the management of blast lung injury.

Modeling cumulative sound exposure around marine seismic surveys

This article presents a method for reducing the computation time required for estimating cumulative sound exposure levels. Sound propagation has to be computed from every source position to every desired receiver location; so if there are many source positions, then the problem can quickly become computationally expensive. The authors' solution to this problem is to extract all possible source-receiver pathways and to cluster these with a self-organizing neural net. Sound propagation is modeled only for the cluster centroids and extrapolated for the entire geographic region. The tool is illustrated for the example of a marine seismic survey over a tropical coral reef. Resident fish species were expected not to flee the reef, but to stay among the corals for the entire duration of the survey. In such cases, the modeling of cumulative sound exposure levels is sometimes requested as part of environmental impact assessments. The tool developed combines a seismic source model, a near-field sound propagation model, and a far-field sound propagation model. The neural network reduces the computation time by a factor of 55. The cost is an error in modeled received levels of less than -1+/-3 dB re 1 microPa(2) s.

Development and validation of subject-specific finite element models for blunt trauma study

This study developed and validated finite element (FE) models of swine and human thoraxes and abdomens that had subject-specific anatomies and could accurately and efficiently predict body responses to blunt impacts. Anatomies of the rib cage, torso walls, thoracic, and abdominal organs were reconstructed from X-ray computed tomography (CT) images and extracted into geometries to build FE meshes. The rib cage was modeled as an inhomogeneous beam structure with geometry and bone material parameters determined directly from CT images. Meshes of soft components were generated by mapping structured mesh templates representative of organ topologies onto the geometries. The swine models were developed from and validated by 30 animal tests in which blunt insults were applied to swine subjects and CT images, chest wall motions, lung pressures, and pathological data were acquired. A comparison of the FE calculations of animal responses and experimental measurements showed a good agreement. The errors in calculated response time traces were within 10% for most tests. Calculated peak responses showed strong correlations with the experimental values. The stress concentration inside the ribs, lungs, and livers produced by FE simulations also compared favorably to the injury locations. A human FE model was developed from CT images from the Visible Human project and was scaled to simulate historical frontal and side post mortem human subject (PMHS) impact tests. The calculated chest deformation also showed a good agreement with the measurements. The models developed in this study can be of great value for studying blunt thoracic and abdominal trauma and for designing injury prevention techniques, equipments, and devices.

A Correction for Primary Blast Injury Criteria

BACKGROUND

We review the accepted primary blast injury criteria. We point out a significant systematic error in the criteria due to the use of low-quality pulse duration data in the original criteria.

METHODS

We recalculate the injury criteria using state-of-the-art blast data.

RESULTS

We give the corrected injury criteria in the form of pressure-duration curves, pressure-impulse curves and charge weight-range curves.

CONCLUSIONS

We discuss the practical implications of a naive use of the accepted criteria in the various forms. In general, the criteria based on pulse duration are seen to be over conservative, while the criteria based on impulse are seen to be too liberal.

Modeling of weak blast wave propagation in the lung

Blast injuries of the lung are the most life-threatening after an explosion. The choice of physical parameters responsible for trauma is important to understand its mechanism. We developed a one-dimensional linear model of an elastic wave propagation in foam-like pulmonary parenchyma to identify the possible cause of edema due to the impact load. The model demonstrates different injury localizations for free and rigid boundary conditions. The following parameters were considered: strain, velocity, pressure in the medium and stresses in structural elements, energy dissipation, parameter of viscous criterion. Maximum underpressure is the most suitable wave parameter to be the criterion for edema formation in a rabbit lung. We supposed that observed scattering of experimental data on edema severity is induced by the physiological variety of rabbit lungs. The criterion and the model explain this scattering. The model outlines the demands for experimental data to make an unambiguous choice of physical parameters responsible for lung trauma due to impact load.

Histologic, immunohistochemical, and ultrastructural findings in human blast lung injury

The objective of this autopsy-based study was to investigate the pathology of human blast lung injury using histology, Fat Red 7B staining, immunohistochemistry, and scanning electron microscopy on lung specimens from eight medicolegal autopsy cases of fatal close-range detonations of chemical explosives. The micromorphologic equivalents of human blast lung injury can be summarized as follows: diffuse alveolar overdistension, circumscribed interstitial hemorrhages showing a cufflike pattern around pulmonary vessels, venous air embolism, bone marrow embolism, and pulmonary fat embolism. Hemorrhages within the lung parenchyma that were present in this study in blast victims without coexisting blunt or penetrating chest trauma must be regarded as potentially life-threatening intrapulmonary bleeding sites in survivors. In addition, the potential clinical importance of the presence of massive pulmonary fat embolism, which has, to the best of our knowledge, not been described previously in human blast lung injury, must be emphasized because pulmonary fat embolism may be a leading cause of the rapid respiratory deterioration with progressive hypoxia and development of acute respiratory distress syndrome in blast victims who survive. Furthermore, this study provides evidence that air embolism presenting in blast victims is not a mere ventilation-induced artifact.

A one-dimensional model for the propagation of transient pressure waves through the lung

The propagation of pressure waves in the lung has been investigated by many authors concerned with respiratory physiology, ultrasound medical techniques or thoracic impact injuries. In most of the theoretical studies, the lung has been modeled as an isotropic and homogeneous medium, and by using Hooke's constitutive law (see e.g. Ganesan et al. Respir. Physiol. 110 (1997) 19; Jahed et al. J. Appl. Physiol. 66 (1989) 2675; Grimal et al. C.R. Acad. Sci., Paris 329 (IIb) (2001) 655-662), or more elaborated material laws (see, e.g. Bush and Challener (Proceedings of the International Research Council on Biokinetics Impacts (IRCOBI), Bergish-gladbach, 1988); Stuhmiller et al. J. Trauma 28 (1988) S132; Yang and Wang, Finite element modeling of the human thorax. Web page: http://wwwils.nlm.nih.gov/research/visible/vhpconf98/AUTHORS/YANG/YANG.HTM.). The hypothesis of homogeneous medium may be inappropriate for certain problems. Because of its foam-like structure, the behavior of the lung-even if the air and the soft tissue are assumed to behave like linearly elastic materials-is susceptible to be frequency dependent. In the present study, the lung is viewed as a one-dimensional stack of air and soft tissue layers; wave propagation in such a stack can be investigated in an equivalent mass-spring chain (El-Raheb (J. Acoust. Soc. Am. 94 (1993) 172; Int. J. Solids Struct. 34 (1997) 2969), where the masses and springs, respectively, represent the alveolar walls and alveolar gas. Results are presented in the time and frequency domains. The frequency dependence (cutoff frequency, variations in phase velocity) of the lung model is found to be highly dependent on the mean alveolar size. We found that short pulses induced by high velocity impacts (bullet stopped by a bulletproof jacket) can be highly distorted during the propagation. The pressure differential between two alveoli is discussed as a possible injury criterion.

Biological response to blast overpressure: a summary of modeling

A soldier in training is exposed to a variety of blast sources that can adversely affect his auditory and nonauditory systems. While auditory standards have been formulated for many decades, knowledge about nonauditory effects of blast have not been captured in a criterion that can be applied to all circumstances. For the past 15 years, JAYCOR, working together with the Walter Reed Army Institute of Research, has been using modeling, simulation, and data analysis to determine the nature of injury in animal models, capture that understanding in physiologically correct mathematical models, and extend the findings to objective criteria that can be used to set exposure limits. This paper summarizes the accomplishments of that effort.

Maximal exercise performance-impairing effects of simulated blast overpressure in sheep

Lung contusion has been identified as a primary blast injury. These experiments addressed a fundamental and overt endpoint of primary blast injury, incapacitation (performance decrement). Respiration, hemodynamics, and blood gases were measured in sheep undergoing incremental exercise challenge before and 1 h after simulated blast exposure of the thorax. Pathologic examination of lung tissue was performed after exposure and exercise testing. Blast overpressure was simulated in the laboratory using a compressed air-driven shock tube. Three levels of lung injury (Levels 1-3, 'Trivial', 'Slight', and 'Moderate' injury, respectively) were examined for effects on maximal oxygen consumption (VO[2max]), an index of cardiorespiratory fitness. Resting hemodynamics and blood gases were relatively normal an hour after exposure, immediately before exercise. However, Levels 1-3 lung injury were associated with average 4.8, 29.9 and 49.3% VO(2max). decreases, respectively. These performance decrements for Levels 2 and 3 were significantly different from respective controls (non-exposed). Exercise caused significant hemoconcentration in sheep under control conditions, before exposure (resting 9.5 +/- 0.9, end-exercise 11.8 +/- 0.9 g/100 ml). Blast exposure resulted in average decreases of 4.9 +/- 3.4, 12.8 +/- 4.0, and 12.6 +/- 3.3% in exercise-induced hemoconcentration for Levels 1-3 injury, respectively. Normal exercise-induced hemodynamic increases were also attenuated after exposure. Levels 2 and 3 injury resulted in average 22.6 +/- 2.9 and 18.5 +/- 11.2% stroke volume decreases, and also 22.3 +/- 8.4 and 29.0 +/- 14.2% cardiac output decreases, respectively, during exercise. While blast lung pathology and pulmonary function changes could account for post-blast performance decrements, these experiments suggest that in sheep, early after exposure, diminished hemoconcentration and cardiac disfunction may also contribute to decreased exercise performance.

The pathology of primary blast overpressure injury

Primary blast injury occurs in civilian and military detonations and from the firing of weapon systems. The pathology of primary blast injury has been reported for the last 70 years and has primarily been limited to descriptions of gross pathology and histology. Commonly accepted tenets have not been confirmed as blast overpressure experiments in enclosures and with multiple detonations have been conducted. Organ systems other than the ear and the lung are playing a greater role in injury definition and research importance. This paper is an overview and update of the current understanding of the pathology of primary blast injury.