Genesis of Antibiotic Resistance (AR) LXXXII: Turbulence Modeling(TM) of Hemodynamics in Simplified Severe Sepsis Protocol‐2 (SSSP‐2)‐NCT01663701: The “Von Kármán Vortex Street” (Vasospasm probability index(VPI)) Fillip Zone of Obstruction Consequent Comatose to ihm

Abstract

Based on Flow‐3DÒ Hydro FD simulation Model 04 (Courtesy: Flow‐3DÒ), clinical data for spontaneous subarachnoid hemorrhage (SAH) and flow gauge, here we present a plausible physiological basis for fluid bolus induced alteration of velocity profile with a fluid volume expansion, that leads to 100% ihm usual care cohort of SSSP‐2 (PMID: 28973227). Subsequent to SAH, an increase in blood flow velocity in cerebral arteries has been observed. The blood flow velocity after SAH was observed to be between 73 and 215 cm/sec (the frequency range of the pure tones: 140 to 820 Hz). The murmurs occurred after SAH has been suggested to be a transitional state between silent flow(laminar) and the phenomenon of bruit (DDx: Carotid Artery Stenosis, carotid cavernous fistula, fibromuscular dysplasia, Takayasu’s arteries, arteriovenous fistula). The cause of the murmur has been suggested to be periodic shedding of vortices in the cerebral arteries, referred to as “a von Kármán vortex street”.Murmurs are an indication of a pathological increase in blood velocities to reflect the degree of spasm(vascular) (PMID: 6689725). VPI, is a combination of transcranial Doppler(TCD) velocities, cerebral blood flow, and clinical risk factors to predict cerebral vasospasm after aneurysmal SAH (PMID: 18077946). Geometry: Lindegaard ratios and spasm indexes (TCD velocities/hemispheric CBF) to evaluate the probability of cerebral vasospasm after aneurysmal SAH. An increase in blood flow velocity (BFV) is the principal criterion for vasospasm. The Middle Cerebral Artery (MCA) /internal carotid artery (ICA) index (Lindegaard Index) is used to distinguish between vasospasm and cerebral hyperperfusion. The intracranial arteriovenous index (AVI) is used to assess vasospasm after SAH. (PMID 29243981). CPP=MAP‐ICP. The blood flow rate in carotid arteries, Table 4.14 p172, ISBN 9780128024089. Governing Equation:Part A: Strouhal number (St): This formula will generally hold true for the range 250 < Red < 200000: St=0.198 (1‐19.7/Red); where St=fd/U, f = vortex shedding frequency, d = diameter of the cylinder, U = flow velocity.Part B: To calculate pressure drop in cylindrical pipe Poiseuille Equation (Hagen‐Poiseuille Eq): Vmax= DPR2 / 4μL, (Eq 1.47, p32) where DP= pressure difference between the two ends, μ = dynamic viscosity, L= length of the pipe, Q= volumetric flow rate, π = 22/7 @3.14, R= pipe radius. For volumetric flow rate (Q) equals cross‐section area multiplied by velocity (Q=ṼA), so DP=8μL/πR4. To represent pressure drop and flow rate in cerebral arteries Poiseuille’s equation is written as Q=DP π R4/ 8ηL where η = viscosity. Derivation and Prospect:Taken together, direct correlation of S&SX of SSSP‐2 (NCT01663701), that subsequent to the fluid bolus, the usual care cohort of SSSP‐2, may have had SAH within 24 to 48 hrs. During that period the LPE aggregates‐toxins of AR‐ClPrs origin forming the ZoO with a concurrent increase ICP, CBF, CBV, PRx, CPPopt, may have caused the cerebral vessel collapse eliciting CCP followed by 100% ihm.