Computational modelling of lung injury: is there potential for benefit?

Harvey, Dan; Hardman, Jonathan G.

doi:10.1098/rstb.2010.0250

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…In such circumstances in excess of 80% of survivors may suffer PBLI. 15 Some 94% of serious casualties in the Madrid train bombings suffered PBLI. 16 PBLI is likely to become increasingly relevant in future conflicts for several reasons.…”

Section: Incidence and Presentationmentioning

confidence: 99%

Primary blast lung injury - a review

Scott¹,

Kirkman

Haque

et al. 2017

British Journal of Anaesthesia

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Bomb or explosion-blast injuries are likely to be increasingly encountered as terrorist activity increases and pre-hospital medical care improves. We therefore reviewed the epidemiology, pathophysiology and treatment of primary blast lung injury. In addition to contemporary military publications and expert recommendation, an EMBASE and MEDLINE search of English speaking journals was undertaken using the medical subject headings (MeSHs) ‘blast injury’ and ‘lung injury’. Review articles, retrospective case series, and controlled animal modelling studies published since 2000 were evaluated. 6-11% of military casualties in recent conflicts have suffered primary blast lung injury but the incidence increases to more than 90% in terrorist attacks occurring in enclosed spaces such as trains. The majority of victims require mechanical ventilation and intensive care management. Specific therapies do not exist and treatment is supportive utilizing current best practice. Understanding the consequences and supportive therapies available to treat primary blast lung injury are important for anaesthetists.

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Section: Incidence and Presentationmentioning

confidence: 99%

Primary blast lung injury - a review

Scott¹,

Kirkman

Haque

et al. 2017

British Journal of Anaesthesia

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“…The academicals deconstruction and dissection of the complex event makes a clear difference with anatomic or mathematical clarity in spite, the fact, that only milliseconds are separating them. The different mathematical models (12), offering explanation gained in animal experiments (13,14) agree in the stepwise description. The very first injury is the direct tissue damage caused by the blast shock wave (primary) followed by the flying pieces hitting casualty (secondary).…”

Section: Mechanismsmentioning

confidence: 83%

Blast injures to the thorax

Sziklavári

Molnár

2019

J. Thorac. Dis

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One out of 10 of military casualties and 6-9 out of 10 civilian victims of terror incidents suffer pulmonary blast injuries when the attackers use explosives as weapon. No specific therapy exists for the primary, shock-wave injury to the lung. The treatment protocols are based on mechanical ventilation, intensive therapy and supportive care. Secondary and tertiary blast structural injuries to the thorax require damage control surgery, dominated by pleural space management (drainage) and haemorrhage control (thoracotomy if needed). Parenchyma resection of irreversibly destroyed lung is rarely needed, and nonanatomical resections are to be preferred. Delayed chest wall reconstruction follows haemodynamic stabilisation and completion of demarcation process. Blast injury to the chest requires a multidisciplinary approach, where the outcome is strongly influenced by the concomitant injuries.

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“…Most computational models of blast trauma target the head and brain. However, models of other organs, such as the lung, have been developed (144).…”

Section: Computer Modelsmentioning

confidence: 99%

A Critical Review of Anaesthetised Animal Models and Alternatives for Military Research, Testing and Training, with a Focus on Blast Damage, Haemorrhage and Resuscitation

Combes

2013

Altern Lab Anim

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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.

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Computational modelling of lung injury: is there potential for benefit?

Cited by 5 publications

References 31 publications

Primary blast lung injury - a review

Primary blast lung injury - a review

Blast injures to the thorax

A Critical Review of Anaesthetised Animal Models and Alternatives for Military Research, Testing and Training, with a Focus on Blast Damage, Haemorrhage and Resuscitation

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