Abstract
Thoracic blunt trauma is evident in up to one-fifth of all hospital admissions, and is second only to head trauma in motor vehicle crashes. One of the most problematic injury mechanisms associated with blunt thoracic trauma is pulmonary contusion, occurring in up to 75% of blunt thoracic trauma cases. The source and effects of pulmonary contusion caused by blunt lung injury are not well defined, especially within the field of continuum biomechanics. This, paired with unreliable diagnostics for pulmonary contusion, leads to uncertainty in both the clinical entity and mechanics of how to predict the presence of injury. There is a distinct need to combine the clinical aspects with mechanical insights through the identification and mitigation of blunt lung trauma and material testing and modeling. This is achieved through using the mechanical insights of lung tissue behavior in order to better understand the injurious mechanisms and courses of treatment of blunt-caused pulmonary contusion. This paper hopes to act as a step forward in connecting two perspectives of blunt lung injury, the clinical entity, and mechanical testing and modeling, by reviewing the known literature and identifying the unknowns within the two related fields. Through a review of related literature, clinical evidence is correlated to mechanical data to gain a better understanding of what is being missed in identification and response to blunt lung injury as a whole.
Issue Section:
Review Article
References
1.
Lum
,
H.
, and
Mitzner
,
W.
, 1987
, “
A Species Comparison of Alveolar Size and Surface Forces
,” J. Appl. Physiol.
,
62
(5
), pp. 1865
–1871
.10.1152/jappl.1987.62.5.18652.
Crosfill
,
M. L.
, and
Widdicombe
,
J. G.
, 1961
, “
Physical Characteristics of the Chest and Lungs and the Work of Breathing in Different Mammalian Species
,” J. Physiol.
,
158
(1
), pp. 1
–14
.10.1113/jphysiol.1961.sp0067503.
Millar
,
A. B.
, and
Denison
,
D. M.
, 1989
, “
Vertical Gradients of Lung Density in Healthy Supine Men
,” Thorax
,
44
(6
), pp. 485
–490
.10.1136/thx.44.6.4854.
Ganie
,
F. A.
,
Lone
,
H.
,
Lone
,
G. N.
,
Wani
,
M. L.
,
Singh
,
S.
,
Dar
,
A. M.
,
Wani
,
N.-U.-D.
,
Wani
,
S. N.
, and
Nazeer
,
N.-U.
, 2013
, “
Lung Contusion: A Clinico-Pathological Entity With Unpredictable Clinical Course
,” Bull. Emer. Trauma
,
1
(1
), pp. 7
–16
.https://pubmed.ncbi.nlm.nih.gov/27162815/5.
Yamamoto
,
L.
,
Schroeder
,
C.
,
Morley
,
D.
, and
Beliveau
,
C.
, 2005
, “
Thoracic Trauma: The Deadly Dozen
,” Crit. Care Nurs. Q.
,
28
(1
), pp. 22
–40
.10.1097/00002727-200501000-000046.
Cohn
,
S. M.
, 1997
, “
Pulmonary Contusion: Review of the Clinical Entity
,” J. Trauma Inj. Infect. Crit. Care
,
42
(5
), pp. 973
–979
.10.1097/00005373-199705000-000337.
Wagner
,
R. B.
,
Crawford
,
W. O.
, and
Schimpf
,
P. P.
, 1988
, “
Classification of Parenchymal Injuries of the Lung
,” Thorac. Radiol.
,
167
(1
), pp. 77
–82
.10.1148/radiology.167.1.33477518.
Miller
,
D. L.
, and
Mansour
,
K. A.
, 2007
, “
Blunt Traumatic Lung Injuries
,” Thorac. Surg. Clin.
,
17
(1
), pp. 57
–61
.10.1016/j.thorsurg.2007.03.0179.
Grimal
,
Q.
,
Naïli
,
S.
, and
Watzky
,
A.
, 2005
, “
A High-Frequency Lung Injury Mechanism in Blunt Thoracic Impact
,” J. Biomech.
,
38
(6
), pp. 1247
–1254
.10.1016/j.jbiomech.2004.06.01010.
Fallon
,
M.
, 2005
, “
Lung Injury in the Intact Thorax With Report of a Case
,” Brit. J. Surg.
,
28
(109
), pp. 39
–49
.10.1002/bjs.1800281090511.
Ross
,
J. M.
, 1941
, “
Haemorrhage Into the Lungs in Cases of Death Due to Trauma
,” BMJ
,
1
(4176
), pp. 79
–80
.10.1136/bmj.1.4176.7912.
Rashid
,
M. A.
, 2000
, “
Contre-Coup Lung Injury: Evidence of Existence
,” J. Trauma Acute Care Surg.
,
48
(3
), p. 530
.10.1097/00005373-200003000-0002813.
Bush
,
I. S.
, and
Challener
,
S. A.
, 1988
, “Finite Element Modelling of Non-Penetrating Thoracic Impact
,” p. 12
.https://trid.trb.org/view/32579314.
Nema
,
S.
,
Pai
,
D.
,
Sinha
,
N.
, and
Gupta
,
K.
, 2013
, “
A Unique Case of Non- Traumatic Asymmetric Shoulder Dislocation With Four-Part Fractures of Proximal Humeri Following Seizures
,” J. Emerg. Trauma Shock
,
6
(3
), p. 231
.10.4103/0974-2700.11535815.
Gryth
,
D.
,
Rocksén
,
D.
,
Persson
,
J. K. E.
,
Arborelius
,
U. P.
,
Drobin
,
D.
,
Bursell
,
J.
,
Olsson
,
L.-G.
, and
Kjellström
,
T. B.
, 2007
, “
Severe Lung Contusion and Death After High-Velocity Behind-Armor Blunt Trauma: Relation to Protection Level
,” Military Med.
,
172
(10
), pp. 1110
–1116
.10.7205/MILMED.172.10.111016.
Gayzik
,
F. S.
,
Hoth
,
J. J.
, and
Stitzel
,
J. D.
, 2011
, “
Finite Element–Based Injury Metrics for Pulmonary Contusion Via Concurrent Model Optimization
,” Biomech. Model. Mechanobiol.
,
10
(4
), pp. 505
–520
.10.1007/s10237-010-0251-517.
Drobin
,
D.
,
Gryth
,
D.
,
Persson
,
J. K. E.
,
Rocksen
,
D.
,
Arborelius
,
U. P.
,
Olsson
,
L.-G.
,
Bursell
,
J.
, and
Kjellstrom
,
B. T.
, 2007
, “
Electroencephalogram, Circulation, and Lung Function After High-Velocity Behind Armor Blunt Trauma
,” J. Trauma Inj. Infect. Crit. Care
,
63
(2
), pp. 405
–413
.10.1097/01.ta.0000236015.68105.4818.
Raghavendran
,
K.
,
Davidson
,
B. A.
,
Helinski
,
J. D.
,
Marschke
,
C. J.
,
Manderscheid
,
P.
,
Woytash
,
J. A.
,
Notter
,
R. H.
, and
Knight
,
P. R.
, 2005
, “
A Rat Model for Isolated Bilateral Lung Contusion From Blunt Chest Trauma
,” Anesth. Analg.
,
101
(5
), pp. 1482
–1489
.10.1213/01.ANE.0000180201.25746.1F19.
Rafaels
,
K. A.
,
Bass
,
C. R.
,
Panzer
,
M. B.
, and
Salzar
,
R. S.
, 2010
, “
Pulmonary Injury Risk Assessment for Long-Duration Blasts: A Meta-Analysis
,” J. Trauma Inj. Infect. Crit. Care
,
69
(2
), pp. 368
–374
.10.1097/TA.0b013e3181e8812220.
Bowen
,
I. G.
,
Fletcher
,
E. R.
, and
Richmond
,
D. R.
, 1968
, Estimate of Man's Tolerance to the Direct Effects of Air Blast
,
Defense Technical Information Center
,
Fort Belvoir, VA
.21.
Bass
,
C. R.
,
Rafaels
,
K. A.
, and
Salzar
,
R. S.
, 2008
, “
Pulmonary Injury Risk Assessment for Short-Duration Blasts
,” J. Trauma Inj. Infect. Crit. Care
,
65
(3
), pp. 604
–615
.10.1097/TA.0b013e3181454ab422.
Viano
,
D. C.
, 1991
, “
Live Fire Testing - Assessing Blunt Impact and Acceleration Injury Vulnerabilities
,” Mil. Med.
,
156
(11
), pp. 589
–595
.10.1093/milmed/156.11.58923.
Raghavendran
,
K.
,
Davidson
,
B. A.
,
Hutson
,
A. D.
,
Helinski
,
J. D.
,
Nodzo
,
S. R.
,
Notter
,
R. H.
, and
Knight
,
P. R.
, 2009
, “
Predictive Modeling and Inflammatory Biomarkers in Rats With Lung Contusion and Gastric Aspiration
,” J. Trauma Inj., Infect., Crit. Care
,
67
(6
), pp. 1182
–1190
.10.1097/TA.0b013e318187a2bf24.
Matute-Bello
,
G.
,
Frevert
,
C. W.
, and
Martin
,
T. R.
, 2008
, “
Animal Models of Acute Lung Injury
,” Am. J. Physiol.-Lung Cell. Mol. Physiol.
,
295
(3
), pp. L379
–L399
.10.1152/ajplung.00010.200825.
Alfano
,
G. S.
, and
Hale
,
H. W.
, 1965
, “
Pulmonary Contusion
,” J. Trauma Inj. Infect. Crit. Care
,
5
(5
), pp. 647
–659
.10.1097/00005373-196509000-0000926.
Clark
,
G. C.
,
Schecter
,
W. P.
, and
Trunkey
,
D. D.
, 1988
, “
Variables Affecting Outcome in Blunt Chest Trauma: Flail Chest versus Pulmonary Contusion
,” J. Trauma Inj. Infect. Crit. Care
,
28
(3
), pp. 298
–304
.10.1097/00005373-198803000-0000427.
Gayzik
,
F. S.
,
Martin
,
R. S.
,
Gabler
,
H. C.
,
Hoth
,
J. J.
,
Duma
,
S. M.
,
Meredith
,
J. W.
, and
Stitzel
,
J. D.
, 2009
, “
Characterization of Crash-Induced Thoracic Loading Resulting in Pulmonary Contusion
,” J. Trauma: Injury, Infection, Crit. Care
,
66
(3
), pp. 840
–849
.10.1097/TA.0b013e318186251e28.
O'Connor
,
J. V.
,
Kufera
,
J. A.
,
Kerns
,
T. J.
,
Stein
,
D. M.
,
Ho
,
S.
,
Dischinger
,
P. C.
, and
Scalea
,
T. M.
, 2009
, “
Crash and Occupant Predictors of Pulmonary Contusion
,” J. Trauma Inj. Infect. Crit. Care
,
66
(4
), pp. 1091
–1095
.10.1097/TA.0b013e318164d09729.
Danelson
,
K. A.
, and
Stitzel
,
J. D.
, 2015
, “
Finite Element Model Prediction of Pulmonary Contusion in Vehicle-to-Vehicle Simulations of Real-World Crashes
,” Traffic Inj. Prev.
,
16
(6
), pp. 627
–636
.10.1080/15389588.2014.99526630.
Gaewsky
,
J.
,
Jones
,
D.
,
Weaver
,
A.
, and
Stitzel
,
J.
, 2017
, “
A Numerical Approach to Identify Injury Risk Regions Within Soft Tissues of Dynamic Human Body Finite Element Models
,” 25th International Technical Conference on the Enhanced Safety of Vehicles (ESV
), Detroit, MI, June 5–8.https://www-nrd.nhtsa.dot.gov/departments/esv/25th/31.
Weaver
,
A. A.
,
Danelson
,
K. A.
,
Armstrong
,
E. G.
,
Hoth
,
J. J.
, and
Stitzel
,
J. D.
, 2013
, “
Investigation of Pulmonary Contusion Extent and Its Correlation to Crash, Occupant, and Injury Characteristics in Motor Vehicle Crashes
,” Accid. Anal. Prev.
,
50
, pp. 223
–233
.10.1016/j.aap.2012.04.01332.
Danelson
,
K. A.
,
Gayzik
,
F. S.
,
Stern
,
A. R.
,
Hoth
,
J. J.
, and
Stitzel
,
J. D.
, 2011
, “
Design, Development, and Analysis of a Surrogate for Pulmonary Injury Prediction
,” Ann. Biomed. Eng.
,
39
(10
), pp. 2560
–2567
.10.1007/s10439-011-0358-633.
Kishorkumar
,
D. G.
,
Anand
,
P. R.
,
Dayananda
,
R.
,
Ravi
,
N.
, and
Kumar
,
M. P.
, 2015
, “
Blunt Trauma to Chest in Exhumed Body—A Case Review
,” J. Punjab Acad. Foren. Med Toxicol
,
15
(1
), pp. 26
–29
.https://www.researchgate.net/profile/Anand-Rayamane/publication/280521359_Blunt_trauma_to_chest_in_Exhumed_Body-_A_Case_Review/links/55e4820e08ae2fac4722e7aa/Blunt-trauma-to-chest-in-Exhumed-Body-A-Case-Review.pdf34.
Meese
,
M. A.
, and
Sebastianelli
,
W. J.
, 1997
, “
Pulmonary Contusion Secondary to Blunt Trauma in a Collegiate Football Player
,” Clin. J. Sport Med.
,
7
(4
), pp. 309
–310
.https://journals.lww.com/cjsportsmed/abstract/1997/10000/pulmonary_contusion_secondary_to_blunt_trauma_in_a.8.aspx35.
Cannon
,
L.
, 2001
, “
Behind Armour Blunt Trauma—An Emerging Problem
,” J. R. Army Med. Corps
,
147
(1
), pp. 87
–96
.10.1136/jramc-147-01-0936.
Carr
,
D. J.
,
Horsfall
,
I.
, and
Malbon
,
C.
, 2016
, “
Is Behind Armour Blunt Trauma a Real Threat to Users of Body Armour? A Systematic Review
,” J. R. Army Med. Corps
,
162
(1
), pp. 8
–11
.10.1136/jramc-2013-00016137.
Carroll
,
A. W.
, 1978
, “
A New Nonpenetrating Ballistic Injury
,” Ann. Surg.
,
188
(6
), pp. 753
–757
.10.1097/00000658-197812000-0000738.
Prat
,
N.
,
Rongieras
,
F.
,
Sarron
,
J.-C.
,
Miras
,
A.
, and
Voiglio
,
E.
, 2012
, “
Contemporary Body Armor: Technical Data, Injuries, and Limits
,” Eur. J. Trauma Emer. Surg.
,
38
(2
), pp. 95
–105
.10.1007/s00068-012-0175-039.
Nsiampa
,
N. N.
, 2011
, “
Development of a Thorax Finite Element Model for Thoracic Injury Assessment
,” 8th European LS-DYNA Users Conference
, Strasbourg, France, May 23–24, pp. 1–9.https://www.dynalook.com/conferences/8th-europeanls-dyna-conference/session-7/Session7_Paper4.pdf40.
Bir
,
C.
,
Viano
,
D.
, and
King
,
A.
, 2004
, “
Development of Biomechanical Response Corridors of the Thorax to Blunt Ballistic Impacts
,” J. Biomech.
,
37
(1
), pp. 73
–79
.10.1016/S0021-9290(03)00238-041.
Bustamante
,
M.
,
Barker
,
J.
,
Rafaels
,
K. A.
,
Bir
,
C.
,
Singh
,
D.
,
Sathananthan
,
P.
, and
Cronin
,
D.
, 2019
, “
Shell Plate Method of Reconstructing Behind Armour Blunt Trauma Impact Scenarios for Soft Armour Using a Detailed Thorax Model
,” 2019 International Research Council on Biomechanics of Injury, Florence, Italy, Sept. 11–13, pp. 689
–691
.42.
Cronin
,
D. S.
,
Bustamante
,
M. C.
,
Barker
,
J.
,
Singh
,
D.
,
Rafaels
,
K. A.
, and
Bir
,
C.
, 2021
, “
Assessment of Thorax Finite Element Model Response for Behind Armor Blunt Trauma Impact Loading Using an Epidemiological Database
,” ASME J. Biomech. Eng.
,
143
(3
), p. 031007
.10.1115/1.404864443.
Wen
,
Y.
,
Xu
,
C.
,
Wang
,
S.
, and
Batra
,
R. C.
, 2015
, “
Analysis of Behind the Armor Ballistic Trauma
,” J. Mech. Behav. Biomed. Mater.
,
45
, pp. 11
–21
.10.1016/j.jmbbm.2015.01.01044.
Prat
,
N.
,
Rongieras
,
F.
,
Voiglio
,
E.
,
Magnan
,
P.
,
Destombe
,
C.
,
Debord
,
E.
,
Barbillon
,
F.
,
Fusai
,
T.
, and
Sarron
,
J.-C.
, 2010
, “
Intrathoracic Pressure Impulse Predicts Pulmonary Contusion Volume in Ballistic Blunt Thoracic Trauma
,” J. Trauma Injury, Infect. Crit. Care
,
69
(4
), pp. 749
–755
.10.1097/TA.0b013e3181f2fe3045.
Cohn
,
S. M.
, and
DuBose
,
J. J.
, 2010
, “
Pulmonary Contusion: An Update on Recent Advances in Clinical Management
,” World J. Surg.
,
34
(8
), pp. 1959
–1970
.10.1007/s00268-010-0599-946.
Miller
,
P. R.
,
Croce
,
M. A.
,
Bee
,
T. K.
,
Qaisi
,
W. G.
,
Smith
,
C. P.
,
Collins
,
G. L.
, and
Fabian
,
T. C.
, 2001
, “
ARDS After Pulmonary Contusion: Accurate Measurement of Contusion Volume Identifies High-Risk Patients
,” J. Trauma Inj. Infect. Crit. Care
,
51
(2
), pp. 223
–230
.10.1097/00005373-200108000-0000347.
Erickson
,
D. R.
,
Shinozaki
,
T.
,
Beekman
,
E.
, and
Davis
,
J. H.
, 1971
, “
Relationship of Arterial Blood Gases and Pulmonary Radiographs to the Degree of Pulmonary Damage in Experimental Pulmonary Contusion
,” J. Trauma
,
11
(8
), pp. 689
–694
.10.1097/00005373-197108000-0000748.
Schild
,
H. H.
,
Strunk
,
H.
,
Weber
,
W.
,
Stoerkel
,
S.
,
Doll
,
G.
,
Hein
,
K.
, and
Weitz
,
M.
, 1989
, “
Pulmonary Contusion: CT versus Plain Radiograms
,” J. Comput. Assist. Tomogr.
,
13
(3
), pp. 417
–420
.10.1097/00004728-198905000-0000849.
Gayzik
,
F. S.
,
Hoth
,
J. J.
,
Daly
,
M.
,
Meredith
,
J. W.
, and
Stitzel
,
J. D.
, 2007
, “
A Finite Element-Based Injury Metric for Pulmonary Contusion: Investigation of Candidate Metrics Through Correlation with Computed Tomography
,” Stapp. Car. Crash. J.
, 51, pp. 189
–209
.https://pubmed.ncbi.nlm.nih.gov/18278598/50.
Tyburski
,
J. G.
,
Collinge
,
J. D.
,
Wilson
,
R. F.
, and
Eachempati
,
S. R.
, 1999
, “
Pulmonary_Contusions__Quantifying_the_Lesions_on.Epub
,” J. Trauma Acute Care Surg.
,
46
(5
), pp. 833
–838
.10.1097/00005373-199905000-0001151.
Jin
,
H.
,
Tang
,
L.-Q.
,
Pan
,
Z.-G.
,
Peng
,
N.
,
Wen
,
Q.
,
Tang
,
Y.-Q.
, and
Su
,
L.
, 2014
, “
Ten-Year Retrospective Analysis of Multiple Trauma Complicated by Pulmonary Contusion
,” Milit. Med Res
,
1
(1
), p. 7
.10.1186/2054-9369-1-752.
Alisha
,
C.
, 2015
, “
Risk Factors Affecting the Prognosis in Patients With Pulmonary Contusion Following Chest Trauma
,” JCDR
, 9(8), pp. 17
–19
.10.7860/JCDR/2015/13285.637553.
Miller
,
C.
,
Stolarski
,
A.
,
Ata
,
A.
,
Pfaff
,
A.
,
Nadendla
,
P.
,
Owens
,
K.
,
Evans
,
L.
,
Bonville
,
D.
,
Rosati
,
C.
,
Stain
,
S. C.
, and
Tafen
,
M.
, 2019
, “
Impact of Blunt Pulmonary Contusion in Polytrauma Patients With Rib Fractures
,” Am. J. Surg.
,
218
(1
), pp. 51
–55
.10.1016/j.amjsurg.2019.01.02754.
Antonelli
,
M.
,
Moro
,
M. L.
,
Capelli
,
O.
,
Blasi
,
R. A. D.
,
D'Errico
,
R. R.
,
Conti
,
G.
,
Bufi
,
M.
, and
Gasparetto
,
A.
, 1994
, “
Risk Factors for Early Onset Pneumonia in Trauma Patients
,” Chest.
, 105(1), pp. 224
–228
.10.1378/chest.105.1.22455.
Raghavendran
,
K.
,
Davidson
,
B. A.
,
Woytash
,
J. A.
,
Helinski
,
J. D.
,
Marschke
,
C. J.
,
Manderscheid
,
P. A.
,
Notter
,
R. H.
, and
Knight
,
P. R.
, 2005
, “
The Evolution of Isolated Bilateral Lung Contusion From Blunt Chest Trauma in Rats: Cellular and Cytokine Responses
,” Shock
,
24
(2
), pp. 132
–138
.10.1097/01.shk.0000169725.80068.4a56.
Bulger
,
E. M.
,
Arneson
,
M. A.
,
Mock
,
C. N.
, and
Jurkovich
,
G. J.
, 2000
, “
Rib Fractures in the Elderly
,” J. Trauma Inj. Infect. Crit. Care
,
48
(6
), pp. 1040
–1047
.10.1097/00005373-200006000-0000757.
Kent
,
R.
,
Woods
,
W.
, and
Bostrom
,
O.
, 2008
, “
Fatality Risk and the Presence of Rib Fractures
,” 52nd AAAM Annual Conference
, San Diego, CA, Oct. 6–8, pp. 1–10.https://pubmed.ncbi.nlm.nih.gov/19026224/#:~:text=The%20odds%20ratio%20for%20death,%25%20CI%202.3%2D2.858.
Kollmorgen
,
D. R.
,
Murray
,
K. A.
,
Sullivan
,
J. J.
,
Mone
,
M. C.
, and
Barton
,
R. G.
, 1994
, “
Predictors of Mortality in Pulmonary Contusion
,” Am. J. Surg.
,
168
(6
), pp. 659
–664
.10.1016/S0002-9610(05)80140-059.
Tenney
,
S. M.
, and
Remmers
,
J. E.
, 1963
, “
Comparative Quantitative Morphology of the Mammalian Lung: Diffusing Area
,” Nature
,
197
(4862
), pp. 54
–56
.10.1038/197054a060.
Stitzel
,
J. D.
,
Gayzik
,
F. S.
,
Hoth
,
J. J.
,
Mercier
,
J.
,
Gage
,
H. D.
,
Morton
,
K. A.
,
Duma
,
S. M.
, and
Payne
,
R. M.
, 2005
, “
Development of a Finite Element-Based Injury Metric for Pulmonary Contusion Part I: Model Development and Validation
,” Stapp. Car. Crash. J.
, 49, pp. 1
–19
.https://pubmed.ncbi.nlm.nih.gov/17096278/61.
Shen
,
W.
,
Niu
,
Y.
,
Mattrey
,
R. F.
,
Fournier
,
A.
,
Corbeil
,
J.
,
Kono
,
Y.
, and
Stuhmiller
,
J. H.
, 2008
, “
Development and Validation of Subject-Specific Finite Element Models for Blunt Trauma Study
,” ASME J. Biomech. Eng.
,
130
(2
), p. 021022
.10.1115/1.289872362.
Rater
,
J.-F.
, 2013
, Thorax Soft Tissue Response for Validation of Human Body Models and Injury Prediction
,
Chalmers University of Technology
, Gothenburg, Sweden.63.
Viano
,
D. C.
, and
Warner
,
C. Y.
, 1976
, “
Thoracic Impact Response of Live Porcine Subjects
,” SAE
Paper No. 760823.10.4271/76082364.
Hozain
,
A. E.
,
O'Neill
,
J. D.
,
Pinezich
,
M. R.
,
Tipograf
,
Y.
,
Donocoff
,
R.
,
Cunningham
,
K. M.
,
Tumen
,
A.
,
Fung
,
K.
,
Ukita
,
R.
,
Simpson
,
M. T.
,
Reimer
,
J. A.
,
Ruiz
,
E. C.
,
Queen
,
D.
,
Stokes
,
J. W.
,
Cardwell
,
N. L.
,
Talackine
,
J.
,
Kim
,
J.
,
Snoeck
,
H.-W.
,
Chen
,
Y.-W.
,
Romanov
,
A.
,
Marboe
,
C. C.
,
Griesemer
,
A. D.
,
Guenthart
,
B. A.
,
Bacchetta
,
M.
, and
Vunjak-Novakovic
,
G.
, 2020
, “
Xenogeneic Cross-Circulation for Extracorporeal Recovery of Injured Human Lungs
,” Nat. Med.
,
26
(7
), pp. 1102
–1113
.10.1038/s41591-020-0971-865.
Judge
,
E. P.
,
Hughes
,
J. M. L.
,
Egan
,
J. J.
,
Maguire
,
M.
,
Molloy
,
E. L.
, and
O'Dea
,
S.
, 2014
, “
Anatomy and Bronchoscopy of the Porcine Lung. A Model for Translational Respiratory Medicine
,” Am. J. Respir. Cell. Mol. Biol.
,
51
(3
), pp. 334
–343
.10.1165/rcmb.2013-0453TR66.
Prat
,
N.
,
Rongieras
,
F.
,
de Freminville
,
H.
,
Magnan
,
P.
,
Debord
,
E.
,
Fusai
,
T.
,
Destombe
,
C.
,
Sarron
,
J.-C.
, and
Voiglio
,
E. J.
, 2012
, “
Comparison of Thoracic Wall Behavior in Large Animals and Human Cadavers Submitted to an Identical Ballistic Blunt Thoracic Trauma
,” Foren. Sci. Int.
,
222
(1–3
), pp. 179
–185
.10.1016/j.forsciint.2012.05.02267.
U.S. Department of Justice
, 2008
, “
Ballistic Resistance of Body Armor
,” U.S. Department of Justice, Washington, DC, Standard No. NIJ Standard-0101.06
.https://www.ojp.gov/pdffiles1/nij/223054.pdf68.
Arborelius
,
U. P.
,
Gryth
,
D.
,
Drobin
,
D.
,
Bursell
,
J.
,
Persson
,
J. K. E.
, and
Kjellström
,
B. T.
, 2004
, “
Injuries and Pathophysiology in ‘Well Protected’ Swine Subjected to Behind Armour Blunt Trauma (BABT)
,” p. 8
.69.
Gryth
,
D.
,
Rocksén
,
D.
,
Arborelius
,
U. P.
,
Drobin
,
D.
,
Persson
,
J. K. E.
,
Sondén
,
A.
,
Bursell
,
J.
,
Olsson
,
L.-G.
, and
Kjellström
,
B. T.
, 2008
, “
Bilateral Vagotomy Inhibits Apnea and Attenuates Other Physiological Responses After Blunt Chest Trauma
,” J. Trauma Inj. Infect. Crit. Care
,
64
(6
), pp. 1420
–1426
.10.1097/TA.0b013e318054e24770.
Rocksén
,
D.
,
Gryth
,
D.
,
Druid
,
H.
,
Gustavsson
,
J.
, and
Arborelius
,
U. P.
, 2012
, “
Pathophysiological Effects and Changes in Potassium, Ionised Calcium, Glucose and Haemoglobin Early After Severe Blunt Chest Trauma
,” Injury
,
43
(5
), pp. 632
–637
.10.1016/j.injury.2010.10.00271.
Rocksén
,
D.
,
Arborelius
,
U. P.
,
Gustavsson
,
J.
, and
Günther
,
M.
, 2020
, “
Severe, Transient Pulmonary Ventilation-Perfusion Mismatch in the Lung After Porcine High Velocity Projectile Behind Armor Blunt Trauma
,” Exp. Lung Res.
,
46
(8
), pp. 271
–282
.10.1080/01902148.2020.179724672.
Sondén
,
A.
,
Rocksén
,
D.
,
Riddez
,
L.
,
Davidsson
,
J.
,
Persson
,
J. K.
,
Gryth
,
D.
,
Bursell
,
J.
, and
Arborelius
,
U. P.
, 2009
, “
Trauma Attenuating Backing Improves Protection Against Behind Armor Blunt Trauma
,” J. Trauma Inj. Infect. Crit. Care
,
67
(6
), pp. 1191
–1199
.10.1097/TA.0b013e3181a5b0e173.
Magnan
,
P.
,
Sarron
,
J.-C.
,
Vassout
,
P.
,
Cunha
,
J. D.
, and
Lonjon
,
T.
, 2004
, “
Physiological Results of French BABT Experiments—Comparison with Non Lethal Kinetic Weapons
,” 2004 Proceedings of Personal Armour Systems Symposium (PASS), The Hague, The Netherlands, Sept..74.
Hildebrandt
,
J.
, 1970
, “
Pressure-Volume Data of Cat Lung Interpreted by a Plastoelastic, Linear Viscoelastic Model
,” J. Appl. Physiol.
,
28
(3
), pp. 365
–372
.10.1152/jappl.1970.28.3.36575.
Saraf
,
H.
,
Ramesh
,
K. T.
,
Lennon
,
A. M.
,
Merkle
,
A. C.
, and
Roberts
,
J. C.
, 2007
, “
Mechanical Properties of Soft Human Tissues Under Dynamic Loading
,” J. Biomech.
,
40
(9
), pp. 1960
–1967
.10.1016/j.jbiomech.2006.09.02176.
Weed
,
B.
,
Patnaik
,
S.
,
Rougeau-Browning
,
M.
,
Brazile
,
B.
,
Liao
,
J.
,
Prabhu
,
R.
, and
Williams
,
L.
, 2015
, “
Experimental Evidence of Mechanical Isotropy in Porcine Lung Parenchyma
,” Materials
,
8
(5
), pp. 2454
–2466
.10.3390/ma805245477.
Hoppin
,
F. G.
,
Lee
,
G. C.
, and
Dawson
,
S. V.
, 1975
, “
Properties of Lung Parenchyma in Distortion
,” J. Appl. Physiol.
,
39
(5
), pp. 742
–751
.10.1152/jappl.1975.39.5.74278.
West
,
J. B.
, and
Matthews
,
F. L.
, 1972
, “
Stresses, Strains, and Surface Pressures in the Lung Caused by Its Weight
,” J. Appl. Physiol.
,
32
(3
), pp. 332
–345
.10.1152/jappl.1972.32.3.33279.
Vawter
,
D. L.
,
Fung
,
Y. C.
, and
West
,
J. B.
, 1978
, “
Elasticity of Excised Dog Lung Parenchyma
,” Am. Physiol. Soc.
,
45
(2
), pp. 261
–269
.10.1152/jappl.1978.45.2.26180.
Zeng
,
Y. J.
,
Yager
,
D.
, and
Fung
,
Y. C.
, 1987
, “
Measurement of the Mechanical Properties of the Human Lung Tissue
,” ASME J. Biomech. Eng.
,
109
(2
), pp. 169
–174
.10.1115/1.313866181.
Sugihara
,
T.
,
Martin
,
C. J.
, and
Hildebrandt
,
J.
, 1971
, “
Length-Tension Properties of Alveolar Wall in Man
,” J. Appl. Physiol.
,
30
(6
), pp. 874
–878
.10.1152/jappl.1971.30.6.87482.
Gao
,
J.
,
Huang
,
W.
, and
Yen
,
R. T.
, 2006
, Mechanical Properties of Human Lung Parenchyma
, International ISA Biomedical Sciences Instrumentation Symposium,
Terre Haute
,
IN, Apr. 7–9
.83.
Bel-Brunon
,
A.
,
Kehl
,
S.
,
Martin
,
C.
,
Uhlig
,
S.
, and
Wall
,
W. A.
, 2014
, “
Numerical Identification Method for the Non-Linear Viscoelastic Compressible Behavior of Soft Tissue Using Uniaxial Tensile Tests and Image Registration—Application to Rat Lung Parenchyma
,” J. Mech. Behav. Biomed. Mater.
,
29
, pp. 360
–374
.10.1016/j.jmbbm.2013.09.01884.
Rausch
,
S. M. K.
,
Martin
,
C.
,
Bornemann
,
P. B.
,
Uhlig
,
S.
, and
Wall
,
W. A.
, 2011
, “
Material Model of Lung Parenchyma Based on Living Precision-Cut Lung Slice Testing
,” J. Mech. Behav. Biomed. Mater.
,
4
(4
), pp. 583
–592
.10.1016/j.jmbbm.2011.01.00685.
Suki
,
B.
, and
Bates
,
J. H. T.
, 2011
, “
Lung Tissue Mechanics as an Emergent Phenomenon
,” J. Appl. Physiol.
,
110
(4
), pp. 1111
–1118
.10.1152/japplphysiol.01244.201086.
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
,” ASME J. Biomech. Eng.
, 110(1), pp. 50
–56
.10.1115/1.310840587.
Lau
,
V.-K.
, and
Viano
,
D. C.
, 1981
, “
Influence of Impact Velocity and Chest Compression on Experimental Pulmonary Injury Severity in Rabbits
,” J. Trauma
,
21
(12
), pp. 1022
–1028
.10.1097/00005373-198112000-0000388.
Viano
,
D. C.
, and
Lau
,
I. V.
, 1988
, “
A Viscous Tolerance Criterion for Soft Tissue Injury Assessment
,” J. Biomech.
,
21
(5
), pp. 387
–399
.10.1016/0021-9290(88)90145-589.
Yen
,
R. T.
,
Fung
,
Y. C.
, and
Liu
,
S. Q.
, 1988
, “
Trauma of Lung Due to Impact Load
,” J. Biomech.
,
21
(9
), pp. 745
–753
.10.1016/0021-9290(88)90283-790.
Wang
,
N.
,
Stevens
,
M. H.
,
Doty
,
D. B.
, and
Hammond
,
E. H.
, 2003
, “
Blunt Chest Trauma: An Experimental Model for Heart and Lung Contusion
,” J. Trauma Inj. Infect. Crit. Care
,
54
(4
), pp. 744
–749
.10.1097/01.TA.0000052362.40754.F291.
Hanlon
,
E.
, and
Gillich
,
P.
, 2012
, “
Origin of the 44-Mm Behind-Armor Blunt Trauma Standard
,” Milit. Med.
,
177
(3
), pp. 333
–339
.10.7205/MILMED-D-11-0030392.
Liden
,
E.
,
Berlin
,
R.
,
Janzon
,
B.
,
Schantz
,
B.
, and
Seeman
,
T.
, 1988
, “
Some Observations Relating to Behind-Body Armour Blunt Trauma Effects Caused by Ballistic Impact
,” J. Trauma
,
27
(1
), pp. 145
–148
.10.1097/00005373-198801001-0002993.
Wang
,
L.
,
Lai
,
X.
,
Zhang
,
B.
,
Su
,
Z.
,
Huang
,
Y.
, and
Wang
,
L.
, 2013
, “
Characteristics of Behind Armor Blunt Trauma Produced by Bullets With Different Structural Materials: An Experimental Study
,” Med. J. Chin. People's Liberat. Army
,
38
(7
), pp. 601
–604
.http://www.plamj.org/index.php/plamj/article/view/75294.
Cui
,
J.
,
Rapo
,
M.
,
Mathews
,
K.
,
Webber
,
C.
, and
Ng
,
L.
, 2021
, “
Biomechanically Based Correlate for Localized Lung Contusion From Nonlethal Blunt Impact Projectiles
,” Milit. Med.
,
186
(Suppl_1
), pp. 331
–338
.10.1093/milmed/usaa35395.
Shen
,
W.
,
Niu
,
E.
,
Webber
,
C.
,
Huang
,
J.
, and
Bykanova
,
L.
, 2012
, Advanced Total Body Model (ATBM) Analyst's Guide for Model Verification and Validation
, San Diego, CA, Technical Report No. J0939‐10‐389
.96.
Bass
,
C. R.
,
Salzar
,
R. S.
,
Lucas
,
S. R.
,
Davis
,
M.
,
Donnellan
,
L.
,
Folk
,
B.
,
Sanderson
,
E.
, and
Waclawik
,
S.
, 2006
, “
Injury Risk in Behind Armor Blunt Thoracic Trauma
,” Int. J. Occup. Saf. Ergon.
,
12
(4
), pp. 429
–442
.10.1080/10803548.2006.1107670297.
Eaton
,
M. A. K.
,
Henderson
,
K. A.
,
McMahon
,
J. A.
, and
Salzar
,
R. S.
, 2020
, “
Testing the Validity of the NIJ Clay Standard for Approving Body Armor With a Preliminary Insight Into Injury Correlation
,” ASME
Paper No. IMECE2020-23886.10.1115/IMECE2020-2388698.
Iwaskiw
,
A.
,
Wickwire
,
A.
,
Vignos
,
M.
,
Howes
,
C.
,
Hahne
,
N.
,
Injeian
,
A.
,
Bevan
,
M.
,
Bar-Kochba
,
E.
,
Mazuchowski
,
E.
,
Clark
,
M.
, and
Drewry
,
D.
, 2020
, “
Initial Injury Observations in Postmortem Human Subjects: Non-Penetrating Ballistic Impacts Over the Sternum With Light- Weight Hard Armour Plates
,” 2020 Personal Armour Systems Symposium (PASS)
, p. 10
.99.
Cronin
,
D.
,
Rafaels
,
K.
,
Bir
,
C.
,
Barker
,
J.
,
Singh
,
D.
,
Bustamante
,
M.
, and
Sathananthan
,
P.
, 2018
, “
Reconstruction of Behind Armour Blunt Trauma Impact Scenarios for Soft Armour Using a Detailed Thorax Model
,” IRCOBI
, Athens, Greece, Sept. 12–14.http://www.ircobi.org/wordpress/downloads/irc18/pdffiles/109.pdf100.
Sturdivan
,
L. M.
,
Viano
,
D. C.
, and
Champion
,
H. R.
, 2004
, “
Analysis of Injury Criteria to Assess Chest and Abdominal Injury Risks in Blunt and Ballistic Impacts
,” J. Trauma Inj. Infect. Crit. Care
,
56
(3
), pp. 651
–663
.10.1097/01.TA.0000074108.36517.D4101.
Yuen
,
K. F.
, and
Cronin
,
D. S.
, 2010
, “
Comparison of Lung Response and Thoracic Injury Metrics
,”
C. T.
Lim
, and
J. C. H.
Goh
, eds.,
Springer Berlin Heidelberg
,
Berlin, Heidelberg
, pp. 501
–504
.102.
Viano
,
D. C.
, 1989
, “
Biomechanical Responses and Injuries in Blunt Lateral Impact
,” SAE Trans.
,
98
(6
), pp. 1690
–1719
.https://www.jstor.org/stable/44472411103.
Fung
,
Y.-C.
, 1974
, “
A Theory of Elasticity of the Lung
,” ASME J. Appl. Mech.
,
41
(1
), pp. 8
–14
.10.1115/1.3423281104.
Fung
,
Y. C.
, 1975
, “
Stress, Deformation, and Atelectasis of the Lung
,” Circul. Res.
,
37
(4
), pp. 481
–496
.10.1161/01.RES.37.4.481105.
Clayton
,
J. D.
, and
Freed
,
A. D.
, 2020
, “
A Constitutive Model for Lung Mechanics and Injury Applicable to Static, Dynamic, and Shock Loading
,” Mech. Soft Mater.
,
2
(1
), p. 3
.10.1007/s42558-020-0018-9106.
Freed
,
A. D.
,
Einstein
,
D. R.
,
Carson
,
J. P.
, and
Jacob
,
R. E.
, 2012
, Viscoelastic Model for Lung Parenchyma for Multi-Scale Modeling of Respiratory System, Phase II: Dodecahedral Micro-Model, U.S. Department of Energy, Oak Ridge, TN, Report No. PNNL-21287-1040678
.https://www.pnnl.gov/main/publications/external/technical_reports/PNNL-21287.pdf107.
Lee
,
G. C.
, and
Frankus
,
A.
, 1975
, “
Elasticity Properties of Lung Parenchyma Derived From Experimental Distortion Data
,” Biophys. J.
,
15
(5
), pp. 481
–493
.10.1016/S0006-3495(75)85832-2108.
Fung
,
Y. B.
,
Tong
,
P.
, and
Patitucci
,
P.
, 1978
, “
Stress and Strain in the Lung
,” J. Eng. Mech. Div.
, 104(1), pp. 201
–223
.https://ascelibrary.org/doi/abs/10.1061/JMCEA3.0002322109.
Vawter
,
D. L.
,
Fung
,
Y. C.
, and
West
,
J. B.
, 1979
, “
Constitutive Equation of Lung Tissue Elasticity
,” ASME J. Biomech. Eng.
,
101
(1
), pp. 38
–45
.10.1115/1.3426222110.
Vawter
,
D. L.
, 1980
, “
A Finite Element Model for Macroscopic Deformation of the Lung
,” ASME J. Biomech. Eng.
,
102
(1
), pp. 1
–7
.10.1115/1.3138193111.
Deng
,
Y.-C.
,
Kong
,
W.
, and
Ho
,
H.
, 1999
, “
Development of a Finite Element Human Thorax Model for Impact Injury Studies
,” SAE
Technical Paper No. 1999-01-0715.10.4271/1999-01-0715112.
Plank
,
G. R.
,
Kleinberger
,
M.
, and
Eppinger
,
R. H.
, 1998
, “
Analytical Investigation of Driver Thoracic Response to Out of Position Airbag Deployment
,” SAE Trans.
, 107(6), pp. 2941
–2954
.http://worldcat.org/isbn/0768002931113.
Grimal
,
Q.
,
Gama
,
B. A.
,
Naili
,
S.
,
Watzky
,
A.
, and
Gillespie
,
J. W.
, 2004
, “
Finite Element Study of High-Speed Blunt Impact on Thorax: Linear Elastic Considerations
,” Int. J. Impact Eng.
,
30
(6
), pp. 665
–683
.10.1016/j.ijimpeng.2003.08.002114.
Roberts
,
J. C.
,
O'Connor
,
J. V.
, and
Ward
,
E. E.
, 2005
, “
Modeling the Effect of Non-Penetrating Ballistic Impact as a Means of Detecting Behind Armor Blunt Trauma
,” J. Trauma Inj. Infect. Crit. Care
,
58
(6
), pp. 1241
–1251
.10.1097/01.TA.0000169805.81214.DC115.
Roberts
,
J. C.
,
Ward
,
E. E.
,
Merkle
,
A. C.
, and
O'Connor
,
J. V.
, 2007
, “
Assessing Behind Armor Blunt Trauma in Accordance With the National Institute of Justice Standard for Personal Body Armor Protection Using Finite Element Modeling
,” J. Trauma Inj. Infect. Crit. Care
,
62
(5
), pp. 1127
–1133
.10.1097/01.ta.0000231779.99416.ee116.
Wang
,
H.-C. K.
, and
Yang
,
K. H.
, 1998
, “
The Development of a Finite Element Human Thoracic Model
,” ASME
Paper No. IMECE1998-0080.10.1115/IMECE1998-0080117.
Freed
,
A. D.
, and
Einstein
,
D. R.
, 2011
, Viscoelastic Model for Lung Parenchyma for Multi-Scale Modeling of Respiratory System Phase I: Hypo-Elastic Model for CFD Implementation, U.S. Department of Energy, Oak Ridge, TN, Report No. PNNL-20340
, p. 1013297.https://www.pnnl.gov/publications/viscoelastic-modellung-parenchyma-multi-scale-modeling-respiratory-system-phase-i118.
Sundaram
,
S. H.
, and
Feng
,
C. C.
, 1977
, “
Finite Element Analysis of the Human Thorax
,” J. Biomech.
,
10
(8
), pp. 505
–516
.10.1016/0021-9290(77)90104-X119.
Yuen
,
K. F.
, 2009
, “
The Development of a Numerical Human Body Model for the Analysis of Automotive Side Impact Lung Trauma
,” University of Waterloo, Waterloo, ON, Canada.120.
Cronin
,
D. S.
, 2012
, “
Application of a Detailed Thorax Model to Investigate Behind Armour Blunt Trauma
,” 2012 Internationl Research Council on Biomechanics of Injury (IRCOBI)
, Dublin, Ireland, Sept. 12–14, p. 873
.http://www.ircobi.org/wordpress/downloads/irc12/default.htm121.
Ruan
,
J.
,
El-Jawahri
,
R.
,
Chai
,
L.
,
Barbat
,
S.
, and
Prasad
,
P.
, 2003
, “
Prediction and Analysis of Human Thoracic Impact Responses and Injuries in Cadaver Impacts Using a Full Human Body Finite Element Model
,” Stapp. Car. Crash. J.
, 47, pp. 299
–321
.https://pubmed.ncbi.nlm.nih.gov/17096254/122.
Kimpara
,
H.
,
Lee
,
J. B.
,
Yang
,
K. H.
,
King
,
A. I.
,
Iwamoto
,
M.
,
Watanabe
,
I.
, and
Miki
,
K.
, 2005
, “
Development of a Three-Dimensional Finite Element Chest Model for the 5th Percentile Female
,” Stapp. Car. Crash. J.
, 49, pp. 251
–269
.10.4271/2005-22-0012123.
Yuen
,
K.
,
Cronin
,
D.
, and
Deng
,
Y.
, 2008
, “
Lung Response and Injury in Side Impact Conditions
,” 2008 International Research Council on Biomechanics of Injury (IRCOBI)
, Bern, Switzerland, Sept. 17–19, p. 12
.http://www.ircobi.org/wordpress/downloads/irc0111/2008/Session2/2_2.pdf124.
Raftenberg
,
M. N.
, 2003
, Response of the Wayne State Thorax Model With Fabric Vest to a 9-mm Bullet,
Army Research Laboratory
,
Aberdeen Proving Ground, MD
, Report No. ARL-TR-2897
.https://www.semanticscholar.org/paper/Response-ofthe-Wayne-State-Thorax-Model-with-Vest-Raftenberg/e892c0e3af06d175caf59cc0199686870b176dbcCopyright © 2022 by ASME
You do not currently have access to this content.
