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Pre-hospital continuous positive airway pressure after blast lung injury and hypovolaemic shock : a modelling study
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Mistry, Sonal, Das, Anup, Hardman, Jonathan G., Bates, Declan G. and Scott, Timothy E. (2022) Pre-hospital continuous positive airway pressure after blast lung injury and hypovolaemic shock : a modelling study. British Journal of Anaesthesia, 128 (2). E151-E157. doi:10.1016/j.bja.2021.10.012
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Official URL: https://doi.org/10.1016/j.bja.2021.10.012
Abstract
In non-traumatic respiratory failure, pre-hospital application of CPAP reduces the need for intubation. Primary blast lung injury (PBLI) accompanied by haemorrhagic shock is common after mass casualty incidents. We hypothesised that pre-hospital CPAP is also beneficial after PBLI accompanied by haemorrhagic shock. We performed a computer-based simulation of the cardiopulmonary response to PBLI followed by haemorrhage, calibrated from published controlled porcine experiments exploring blast injury and haemorrhagic shock. The effect of different CPAP levels was simulated in three in silico patients who had sustained mild, moderate, or severe PBLI (10%, 25%, 50% contusion of the total lung) plus haemorrhagic shock. The primary outcome was arterial partial pressure of oxygen (Pao ) at the end of each simulation. In mild blast lung injury, 5 cm H O ambient-air CPAP increased Pao from 10.6 to 12.6 kPa. Higher CPAP did not further improve Pao . In moderate blast lung injury, 10 cm H O CPAP produced a larger increase in Pao (from 8.5 to 11.1 kPa), but 15 cm H O CPAP produced no further benefit. In severe blast lung injury, 5 cm H O CPAP inceased Pao from 4.06 to 8.39 kPa. Further increasing CPAP to 10-15 cm H O reduced Pao (7.99 and 7.90 kPa, respectively) as a result of haemodynamic impairment resulting from increased intrathoracic pressures. Our modelling study suggests that ambient air 5 cm H O CPAP may benefit casualties suffering from blast lung injury, even with severe haemorrhagic shock. However, higher CPAP levels beyond 10 cm H O after severe lung injury reduced oxygen delivery as a result of haemodynamic impairment. [Abstract copyright: Copyright © 2021 British Journal of Anaesthesia. All rights reserved.]
| Item Type: | Journal Article | ||||||||
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| Divisions: | Faculty of Science, Engineering and Medicine > Engineering > Engineering | ||||||||
| SWORD Depositor: | Library Publications Router | ||||||||
| Journal or Publication Title: | British Journal of Anaesthesia | ||||||||
| Publisher: | Oxford University Press | ||||||||
| ISSN: | 0007-0912 | ||||||||
| Official Date: | 1 February 2022 | ||||||||
| Dates: |
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| Volume: | 128 | ||||||||
| Number: | 2 | ||||||||
| Page Range: | E151-E157 | ||||||||
| DOI: | 10.1016/j.bja.2021.10.012 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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