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Pergamon 0@21-929o(!

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J. Biomechanics, Vol. 29, No. 2, pp. 221.-234, 1996 Copyright 0 1995 Elsevim Science Ltd Printed in Great Britain. All rights r%wed M)Zl-9290/96 $15.00 + 00

A MODEL

OF BLAST

OVERPRESSURE

INJURY

TO THE LUNG

James Stuhmiller,* Kevin H.-H. Ho,* Michael J. Vander Vorst,* Kenneth T. Dodd,? Thomas H. Fitzpatrick? and Maria Mayorgat
*Applied Science and Engineering Technology Group, JAYCOR, 9775 Towne Center Drive San Diego, CA, 92121-1999, U.S.A. and tDepartment of Respiratory Research, Walter Reed Army Institute of Research, Washington, DC, U.S.A.

Abstract-Despite decades animal of experiments, on blast injury to the lung cover only a limited number of data circumstances and are in a fragmented form. This paper develops a mathematical model of the chest wall dynamics and the subsequent generation of strong pressure waves within the lung, which havebeen hypothesized as the mediator of injury. The model has been compared to an extensive database of observed pathologies from animal tests. The incidence of injury and lethality is found to follow a log-normal correlation with the computed total energy in these waves and, when the energy is normalized by the lung volume, the lethality correlation applies to all large animal species. Small animals also correlate with the normalized energy, but at a different value, and it is speculated that structural differences, other than lung volume, may be involved. This relatively simple model allows the potential for blast injury to the lung to be determined from measured or computed pressure traces without additional animal testing. Improved occupational exposure criteria should follow from this methodology. Keywords: Lung; Blast injury; Injury.

ducted under the sponsorship the U.S. Army Medical of Research DevelopmentCommandat its BlastTest Site & Violent explosionsproduce blast waveswhich travel at in Albuquerque, New Mexico. The animal testing has hundreds of meters per secondin air. Primary blast concentrated on a single species,sheep,and careful injury arisesfrom the overpressure the wave which measurements blast-pressuretime-histories and a of of crushes body and damages air containing organs comprehensive the the pathological scoring systemhave been directly, and other organsindirectly. The military recog- employed. These test results have been compiled by nizes blast injury as a factor in combat casualty care JAYCOR in electronicformat so that evaluation of in(Phillips and Richmond, 1991),but it is in the area of jury patterns and testing of theoretical modelscan be occupationalexposurewhere it is emergingas a signifi- accomplished. cant concern. Modern field weaponsuse such highly There have beenseveralhazard estimates developed energeticmunitions that their blastscan exceedcurrent (Dodd et al., 1990;Military Standard1474C,1990, White exposurestandards resultingin restrictedtraining on the et al., 1971)basedon peak pressureand duration, but weapons, which is undesirable preparing the soldier experience shownthat suchcriteria are very sensitive for has for combat. On the civilian front, automobileaccidents to often hard to measure detailsof the pressure trace. In have historically resultedin severehead injury and rib addition to empirical relations,there have been several fracture, however,soft tissue injury can occur well before mechanicallybasedmathematicalmodels(Bowen et al., it would be expectedbasedon accelerationor compres- 1968;Viano and Lau, 1988)that usea combinationsof sion tolerances(Viano and Lau, 1988).This soft tissue springs, masses, dampers simulatethe response and to of injury bearsa striking clinical resemblance blast in- the thorax. Each model has many parameters, to someof jury, suggestingthat similar biomechanicalprocesses which cannot be determinedphysiologicallyand noneof may be at work. the models offersa mechanistic explanation of the injury Most of the animal air blast tests conducted before process itself.Chuong (1985)and Stuhmilleret al. (1988) 1970were concernedwith lethality and are discussed describe FEM modelthat capturesboth the anatomical in a Bowenet al. (1968)and White et al. (1971).Simplewave geometry of the sheepand the wave nature of the lung forms were considered, but a wide range of peak pres- compression. Regionsof large compression tension and suresand durations and a wide rangeof animal species were observedin the vicinity of the tip of the lobes,the were employed.Clemedsen provided much of the early heart, and the spinal process.Each of theseare areas systematicstudiesof blast injuries, including the effects where hemorrhagingis observedin animal tests.Fung on pulmonary gas exchange(Clemedson,1953),gene- et al. (1988) provided a hypothesis injury based the for on ration of air emboli(Clemedson Hultman, 1954), and and alveolar response the compression to wave generated by a generalreview (Clemedson, 1956).The most compre- the chestwall motion. hensivestudiesof blast injury, however,have beenconDespite decades animal experiments,the existing of blastinjury data cover only a limited numberof circumstances and are in a fragmentedform. In this paper we present a systematicorganization of these data. The Received in final form 27 December 1994.
227

INTRODUCTION

228

J. H. Stuhmiller et a/.

lated to the piston velocity time history, has beenconfirmed in tests using a foam lung simulant (Yu et al.. 1990a)and in computational analysesof the lung response (Vander Vorst et al., 1989). Usingthe relationshipconnectingthe chestwall veiocity to the pressure wave generatedin the lung parenchyma, we can construct a single degree of freedom modelfor the pleural surfacedynamicsand derive a formula for the amount of energydeliveredto the lung. For simplicity, we assume the thoracic response blast that to resultsis dominated by the chest wall inertia and the external pressureloading, Pioad, we can ignore the so stresses arisingfrom the rib structure. As a corollary, we assume different sections the thorax act indepenthat of dently to the external loading. Finally, we ignore the METHODS effectsof internal reflectionsof the wave on the motion of the thorax. Stuhmilleret al. (1991)gave a review of the physicsof If we apply Newton’slaw to the local thorax surface, blast and its injury mechanisms. completeunderstand- imaginingthat the chestwall andlung form a rectangular A ing mustincorporate the complexity of the blast loading region,see Fig. 1, then weobtain the equationof motion to the body, the biomechanical response the body, and of the mechanical failure of the tissues. bioengineering The dv m = Plead @)--PO 1 approach replacesempirical correlations, that can be dt ( situation and species dependent,with modelsthat are (4) anatomically and mechanicallycorrect and derive their where v is the velocity, x is the displacement, is the m parametervalues from direct measurement material of wall properties.An application to the tympanic membrane is mass/chest area,and L is the ratio of the volume of the lung/chestwall area.The motion of the chestwall can found in Stuhmiller (1989). The motion of the chestwall into the underlying lung be determinedoncethe external blast loading, &,,d(t), is material resultsin a compression wave. Clemedson and given. Pettersson(1970)were among the first to observelow If the velocity and displacement small,the equation are speedpressure wavesin animalsexposedto blast. The can be linearizedto the form role of rate-dependent injury mechanisms has been studied by many researchers since that time and the readeris referredto the work of Jonsson al. (1979) et and other contained in the review by Stuhmiller (1991).Yen Finally, the normalized work, W*, definedastotal work et al. (1986)quantified the phenomena measuring by the done to produce the wave divided by the volume of the pressurewave through isolated rabbit and goat lung lung and the ambient pressure, be computed using can and found that the wave speed variedfrom 31to 64m s-l the velocity found from equation (5): as the transpulmonary pressure varied from 0 to 20 cm HzO. W* = I= -!m. l; po~,v2&. POV POL Sincethe lung behaves a compressible as material, we can use the derivation of Landau and Lifshitz (1959), Injury is causedby a local excess strain of the tissue, which relatesthe pressure wave in a compressible to whosedetailsare not described this model.A correlate gas by the motion of a piston. The pertinent result is of grosspathology, however,may be related to the average energy dissipatedin the lung tissue, that is, the normalizedwork.

growing military and civilian concernsabout primary blast injury involve so many possiblecombinationsof factorsthat the costsof directly evaluatingnewsituations have becomeprohibitive. Uncertainty about the extrapolation betweenspecies further cloudsthe applicability of animal test results.This paper developsa mathematical modelthat connectsexternal blast conditionsof the chestwall dynamicsand the generationof compression waveswithin the lung for a variety of species. correlaA tion is madebetweenthe energy density of thosewaves and observedinjury. The resultingformulation can provide a rational criterion for blast overpressure hazard to man.

P(t)=Po ( l+&-

1); >$i 9

(1)

wherepo, pO,and c0 are the pressure, density,and speed of soundin the undisturbedlung, v is the velocity of the piston, and y is the ratio of specificheats.If the piston velocity is smallcomparedwith the speed sound,then of the equationcan be expandedto give the linearizedform p(t) 2 PO POCOV, + where we have usedthe adiabatic relation (2)

Fig. 1. Pleural dynamics model. model The considers forces the (3) on the chest wall dueto the externalblastload,the internal pressure arising fromthebulkcompressionthelung,andthe of Relationship(2), that the wave generatedis linearly recompression generated the chest wave by motion.

Model of blast overpressure injury to the lung

229

Assumingthat the anatomical structuresare similar, RESULTS the variation with species be studiedby considering can The extensive observationsof blast injury to sheep variations with body mass.First, we formulate the dymade at the Albuquerque test site, have been classified namicsequation in termsof the dimensionless variables based on area1extent: slight (up to 10%); moderate X and T basedon a time scaler, where (lo-50%); and severe(above 50%). Since 1985a threshold category, trace, has beenadded that denotesthe T2 x(t) = ; X(T). 3 z’ appearance smallpetechia. of Lung weightincreases have alsobeenrecordedand can be usedasan injury marker. (7) Over 1000 animalshave been recorded in the pathoThe dynamicsequation becomes logy database. The testsconducted vary from free field
$+2(3+(3X=/(Th (8)

where fd = Irr
PC ’ t,= mL -. J- PO (9)

Using the scalinglawssuggested Stahl (1967),we can in expect both the chestwall mass unit area,m,and the per linear dimensionof the lung, L, to vary as Ml”, where M is the body massof the animal. Inspection of the equationsabove showsthat if the scalingtime, r, also variesasM”3, then the dynamicsare independent the of body mass.That is, all dynamic results,including the normalizedwork, will be invariant with body mass the if time scales scaledby the cuberoot of the body mass. are Sincethe blast wave surroundsthe body, even in the free field, it is necessary have a prescription for the to distribution of blast loading. For the studiesconducted by WRAIR, a standard Blast Test Device, consistingof a cylinder with pressure instrumentationon each quadrant (Yu et al., 1990b), placedat the position of the test is animal and the loading recorded.The BTD is then removedand the test repeated with the animalin place.For those experimentswhere the BTD has been used, the work generatedin each quadrant is calculatedand totaled. For those experimentswhere only a single,incidencepressure beenmeasured, assumed each has we that of the quadrants is acted upon either by the incident pressure the reflected value, dependingon the body or orientation. SeeFig. 2.

pr
ps

0
ps

PS pS Perpendicular to Blast
PS ps Parallel to Blast

exposuresto explosions in rooms and vehicles and simulations weaponfire. The blastoverpressure of trace(s) associated eachanimalhasbeenstoredelectronically. with Usingthe measured pressure loadson all four sides of the body in complexblast environments, normalized the work hasbeencalculatedfor eachof the animalsin the databaseand correlated with observedpathology. To determine injury incidence relations, the results are groupedinto normalizedwork ranges, from which statistics on the frequencyand extent of injury are computed. A log normal correlation of incidence of injury with normalized work can be madefor eachlevel of injury: thresholdand greater; slight and greater;moderateand greater;and severe (Fig. 3).The probability of occurrence of any injury level can be determined by taking the differenceof the appropriateincidence curves.These correlations form an orderly progressionas normalized work increases. a particular level of incidenceis conIf sidered,say 50%, then the area1 extent of injury can be determined (Fig. 4). The computed normalizedwork hasalso beencorrelated with the total lung weight to body weight fraction. While this quantity is the gold standardof many pathology studies, is not sensitive smallpathologiesunder it to the circumstances where the animalis sacrificedshortly after exposure. Nonetheless, normalizedwork is an excellent correlate and increases from the uninjured population can be detected at levelswhereslightpathologies are first observed(Fig. 5). Also shown is the distribution of lung weightfractionsfor the uninjuredpopulation.When the 95% rangesare superimposed the work correlate, on we see that even the highly injured casesare encompassed, suggesting that the scatter arisesfrom the variation in the animalsbeforeexposure.
DISCUSSION

0
ps

General

‘r

0
‘r

pr

pr

Near Reflecting Surface

Fig. 2. Pressure loading distribution. When available, the measured pressure loads areused. When only the staticpressure, P., ismeasured, quadrants thebodyareloaded P. or the the of with reflected component, P,, depending on the body’s orientation to the blast wave.

A modelhasbeendeveloped that providesa means of estimating incidence severityof injury to the lung the and from air blast.The parameters the modelarephysioloof gically identified and measurable, that resultscan be so extrapolated betweenspecies, injury prediction can and be madefor simpleand complex exposures. The mode1 predictsthe intensity of the compression wave within the lung which is believedto be the mediator of injury. The geometryof the lung and thorax hasbeengreatly simplifiedto consideronly the area of applied load and the total effectivevolume of the lung. Detailsof internal wave propagation, interaction with internal organs, and

230

J. H. Stuhmiller et a/.

80

Fig. 3. Correlation of incidence of injury with normalized work [(A) trace or greater; (A) slight or greater; (0) moderate or greater; and (0) severe]. The occurrence of injury above a certain level follows a log-normal distribution. The probability of the occurrence of a particular level of injury has a bell-shaped distribution that depends on the range of pathologies defined by that level and can be found by taking the difference between the bounding cumulative curves.

1.0 0.9
0.8
I m colEplexwawsludiss(1990-1991) I I I/lll/ll

I dYIIIllI

0.7 c * 2 2 s 0.6 0.5 0.4 t * 0.3 0.2 0.1 0.0 0.001 0.01 0.1 Normallad Work 1 10 100

Fig. 4. Correlation of lung are injured with normalized work. The area is determined by averaging the injured areas of individual animals. Each data point represents a number of test animals, so the vertical error bars represent one standard deviation of the areas and the horizontal bars represent one standard deviation of the calculated work.

viscoelastic forces arising from the thorax itself have been ignored.Without suchfeaturesit is not possible preto

from fluid leakage are correlated with the total energy deposited into the compression wave.

diet the specificlocations of injury, however, the gross Viano and Lau (1988) proposeda viscoelastic modalof pathology of hemorrhage the increase lung weight and of thorax forces, whose parameters were selected to capture

Model of blast overpressure injury to the lung
3.5
q FresFiiSWdiis(1991-1991) CmplexWave~Sbdii1990&1991

231

z E s s 0” g ‘s E :: 5 P E
E, 5 L

3.0
x

2.5

-Injurycorreletll( Mean )
- -lnjuryConelat~(Mean+3xS.D.) ----..lnjuryCorrelation(Mean-3xS.D.)

2.0

1.5

1.0

3 z

0.5

0.0
0.001 0.01

Fig. 5. Correlation of lung weight with normalized work. The increase in lung weight due to fluid leakage correlates with the normalized work generated by the chest wall motion. The variability of lung weights seen in control animals, shown as the dotted band, explains the variability seen under injury conditions.

the relatively largeforce-displacement observed blunt in impact to cadavers. The response modelpresented is here based forcesgenerated the lung and is appropriate on in to the relatively small displacements associatedwith blastloading.Viano and Lau alsoproposed the correas late of injury a quantity VC, which is the maximumof the product of velocity and compression. They showedthat for displacement-driven impact tests,the VC and the energy dissipated one of the damperelements nearly in are equal.For load-driven motion, however,the two quantitiesvery differently with the length of the blast pulseand scaledifferently with body mass. Furthermore, the two quantities can differ significantly with multiple loading, depending on the timing of the loads. Both models, however, sharea key philosophicalperspective: that injury is related to the energy expendedby non-elastic forcesper organ mass. White et al. (1971)providesa compendium lethality of resultsfrom testsconductedat the Albuquerquetest site. Unfortunately, the pressure time-history data have been lost and only the peak valuesand positive phasedurations have survived.The test wereconductedeither in the free field, wherean exponentialwaveformwith a negative phaseapplies (Baker, 1973), in a shocktube,wherethe or shapetends to be triangular. In the absence specific of data, we shall bound our comparisonsby using both formulations. The peak pressureand duration data reported in White et al. (1971)are usedto generate triangular and a Friedlander wave shape,which are then used in the dynamic model. For each case,we compute the normalized work. The conditions producing 50% lethality group into two classes (Fig. 6) the large animalscorres-

pond to W* = 2.08,while the smallanimalscorrespond to W+ = 0.85. The Bowen correlation, a fit to the 50% lethality data in the coordinates peakpressure positive duration, of and hasbeenusedasa standardfor estimating combat injury. It was discoveredthat the data could be collapsedinto a singlecurve if the time axiswasscaled the cuberoot by of the body mass. This correlation can be interpreted as the contour of the more universal criteria, W* = 2.08 [Fig. 7(a)]. A rangedevelopsbecause the uncertainty of of whetherthe wave is triangular or Friedlander-shaped. A similarcorrelationcan beobtainedfor smallanimals [Fig. 7(b)], but for a value of w* = 0.85. If the biomechanicalstructures were truly similar, one would expectthe normalizedwork value to be the same. Examination of the simulationsshowsthat the relative compression the chestis much greaterfor lethality condiof tions than for injury, suggesting that the viscoelastic forcesassociated with the thorax (ignoredin the model) may be important. Sincethe larger animalshave a relatively stiffer thorax, the amount of energy transformed into lung wavesmay be over estimated. The inclusionof viscoelastic forcesfrom the thorax, asdescribed Viano by and Lau (1988)for example,and from the lung, as describedhere,might unify theseresults. White et al. (1991) further report two effectsof the pressure wave shapeon lethality. In the first, wavesthat rise slowly to their peak value have lesslethality than those characterized by a fast rising shock front. Normalized work decreases significantly as the rise time increases [Fig. 8(a)]. White alsoreports that wavesthat reach their peak in steps are lesslethal. Again, normalizedwork is decreased stepped for waves[Fig. 8(b)].

232

J. H. Stuhmiller et al.

0.01

0.1

1 Body waht (kg)

10

100

1c

Fig. 6. Normalized work associated with 50% lethality for various species. Vertical bars represent the uncertainty in the work due to uncertainty in the pressure data. Large and small mammal results group around values 2.08 and 0.85, respectively.

64 Lvne
pOO L -Ftiedfnndar wave .-~~~Triarigle Wave ODog A &A 1000

71

10000 -Fh6landw Wave *---.Ttim@eWava

----I
l fhuse
Rat A
l

I

GuineaPi RabbII

0

100

1
0.1 1 10 loo loo0 loo00

10 0.1 1 10 loo loo0 loo00

Scaled

A-Dumtton

= Ta x (70iM)“’

x (Pd14.7)“’

(nmec)

Fig. 7. Blast characteristics producing 50% lethality in the free field. The 50% lethality conditions reported by Bowen et al. (1968) can be correlated with a single normalized work value for large animals (2.08) and a single value for small animals (0.85). The differences between large and small animals may be related to thoracic forces not considered in the current model.

There is little actual data collected,but White inferred trends of lethality with animal orientation to the blast. Thosetrendscan be reproducedby the normalizedwork criterion if the blast load distribution variations with orientation are taken into account (Fig. 9). We ooncludethat the compression wave generated by rapid chest wall motion under blast loading is respon-

siblefor the lung pathologies and lethality seen and that a predictive correlation can be madebetweenquantitative measures injury and the body-mass-weighted of total wave energy. Di&rences in smal animal response. and the need for predicting location of injury suggest that inclusionof more of the physiologicalstructure may be profitably added.

Model of blast overpressure injury to the lung

233

(a) 3.0

(b) 3.0

2.5

63.1

2.5

63.1

f
P I E 0 *

2.0

2.0

47. z

1.5 \ 1.0 \

27.6

1.5

27.6

P z

9.1

1.0

0.5

0.5

0.5

0.0
0 12 Scaled 1, 3 =I;, 4 5 6 7 0

0.0

0.0 0 2 4 6 0 10 12 14 16 16 20

x(70.0/M)'"

(mr)

ScaiedT,,,,

i5 T,,,.x(

7O.tYNl)‘”

(mr)

Fig. 8. Effect of pressure waveform shape on lethality. Confirming trends reported in White et al. (1971), the injury model predicts that normalized work and lethality are reduced when the pressure wave rises in steps or rises with a finite slope.

Parallel to Blast

0.1

1

10

100

loo0

A-Duration

of Trlrnglr

Pressure

Wave

( msac )

Fig. 9. Effects of body orientation on lethality. Curves depict conditions that produce 50% lethality levels in man ( W* = 2.08) for three orientations of the body to the blast. The curves are nearly identical to those proposed by White et al. (1971). Acknowledgements-The authors acknowledgethe sup- Bowen, G., Fletcher, E. R., Richmond, D. R., Hirsch, F. G. and 1. White, C. S. (1968) Biophysical mechanisms and scaling pro-_ oort of the U.S. Army Medical Research and Develoncedures applicable in assessing responses of the thorax enerkent Commandunder contract DAMD17-93-C-3005: gized by air-blast overpressures or by nonpenetratina missiles. Ann. N.Y. Acad. Sci. i52, 122-146.. Chuong, C. J. (1985) Biomechanical modeling of thorax response to blast loading. Final Report Contract DAMD-17REFERENCES 82-C-2062. JAYCOR, San Diego, California. Clemedson, C. J. (1953) Respiratory and pulmonary gas exchange in blast injury. J. Appl. Physiol. 6, 213-220. Baker, W. E. (1973) Explosions in Air. University of Texas Press, Austin, TX. Clemedson, C. J. (1956) Blast injury. Physiol. Rev. 36, 336-354.

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Clemedson, C. J. and H&man, H. (1954) Air embolism and the cause of death in blast injury. Milit. Surg. 114, 424-437. Clemedson, C.-J. and Pettersson, H. (1970) Propagation of high explosive air shock wave through different parts of an animal body. Am J. Physioi. 100, 24-30. Dodd, K. T., Yelverton, J. T., Richmond, D. R., Morris, J. R. and Ripple, G. R. (1990) Nonauditory injury threshold for repeated intense freefield impulse noise. J. Occup. Med. 32,260-266. Fung, Y. C., Yen, R. T., Tao, Z. L. and Liu, S. Q. (1988) A hypothesis on the mechanism of trauma of lung tissue subjected to impact load. J. Biomech. Engng 110, 50-56. Jonsson, A., Clemedson, C. J., Jonsson, A., Clemedson, C. J., Sundquist, A. B. and Avvebo, E. (1979). Dynamic factors influencing the production of lung injury in rabbits subjected to blunt chest wall impact. Auiat. Space Enu. Med. 50,
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Stuhmiller, J. H. (1989) Use of modeling in predicting tympanic membrane rupture. Ann. Otol. Rhinol. Laryngol. 98, 53-60. Stuhmiller, J. H., Chuong, C. J. Phillips, Y. Y. and Dodd, K. T.

Injuries (Edited by Bellamy, R. F. and Zajtchuk, R.). Office of the Surgeon General. Department of the Army, Washington, DC. Vander Vorst, M. J., Dodd, K. T., Stuhmiller J. H. and Phillips Y. Y. (1989) Calculation of the internal mechanical response of sheep to blast loading. In Proc. 10th Inr. Symp. on Military Applications of Blast Simulation (Edited by Reichenbach, H. and Ackerman, J. H.). Oberjettenber. Germany. Viano. D. C. and Lau. I. V. (19881 A viscous tolerance criterion for soft tissue injury assessment: J. Biomechanics 21, 387-399. White, C. S., Jones, R. K., Damon, E. G.. Fletcher, E. R. and Richmond, D. R. (1971) The biodynamics of airblast. Technical Report DNA2738T, Defense Nuclear Agency, Washington, DC. Yen, R. T., Fung, Y. C., Ho, H. H. and Butterman, G. (1986) Speed of stress wave propagation in lung. J. Appl. Physiol. 61, 701-70s. Yu, J. H.-Y., Ho, H. H. and Stuhmiller, J. H. (1990a) A surrogate model of thoracic responses to blast loading. Final report for USAMRDC Contract DAMD17-85-C-5238. JAYCOR. San Diego, CA. Yu, J. H.-Y., Vasel, E. J. and Stuhmiller, J. H. (1990b) Design and field test of a blast overpressure test module. Final report for USAMRDC Contract DAMD17-85-C-5238, JAYCOR, San Diego, CA.

of Military and Burn

Medicine,

Conoentional

Warfare:

Ballistic,

Blasr