Management of primary blast lung injury: a comparison of airway pressure release versus low tidal volume ventilation

Timothy E. Scott, Anup Das, Mainul Haque, Declan G. Bates, Jonathan G. Hardman

Research output: Journal PublicationArticlepeer-review

6 Citations (Scopus)

Abstract

Background: Primary blast lung injury (PBLI) presents as a syndrome of respiratory distress and haemoptysis resulting from explosive shock wave exposure and is a frequent cause of mortality and morbidity in both military conflicts and terrorist attacks. The optimal mode of mechanical ventilation for managing PBLI is not currently known, and clinical trials in humans are impossible due to the sporadic and violent nature of the disease. Methods: A high-fidelity multi-organ computational simulator of PBLI pathophysiology was configured to replicate data from 14 PBLI casualties from the conflict in Afghanistan. Adaptive and responsive ventilatory protocols implementing low tidal volume (LTV) ventilation and airway pressure release ventilation (APRV) were applied to each simulated patient for 24 h, allowing direct quantitative comparison of their effects on gas exchange, ventilatory parameters, haemodynamics, extravascular lung water and indices of ventilator-induced lung injury. Results: The simulated patients responded well to both ventilation strategies. Post 24-h investigation period, the APRV arm had similar PF ratios (137 mmHg vs 157 mmHg), lower sub-injury threshold levels of mechanical power (11.9 J/min vs 20.7 J/min) and lower levels of extravascular lung water (501 ml vs 600 ml) compared to conventional LTV. Driving pressure was higher in the APRV group (11.9 cmH2O vs 8.6 cmH2O), but still significantly less than levels associated with increased mortality. Conclusions: Appropriate use of APRV may offer casualties with PBLI important mortality-related benefits and should be considered for management of this challenging patient group.

Original languageEnglish
Article number26
JournalIntensive Care Medicine Experimental
Volume8
Issue number1
DOIs
Publication statusPublished - 1 Dec 2020
Externally publishedYes

Keywords

  • Acute respiratory distress syndrome
  • Airway pressure release ventilation
  • Computational modelling
  • Low tidal volume ventilation
  • Primary blast lung injury
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine
  • Physiology (medical)

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