Genesis of Antibiotic Resistance (AR) LXXXVII: Turbulence Modeling(TM) of Hemodynamics in Simplified Severe Sepsis Protocol‐2 (SSSP‐2)‐NCT01663701: Fluid bolus evoked fluid volume expansion Augmented APG, VSF, reprobate to inviscid fluid (Fluid Stalling, Re=∞; viscosity=0) augment IHM
Authors: Flores Jorge , Montoya Hector , Kannan Subburaj 
Published: May 2022

Based on the theoretical inferences derived from industrial CFD modules, and hemodynamic data (SSSP‐2), here we present a plausible physiological basis for the benefit of monitoring ISP for attenuation 100% ihm in the usual care cohort of SSSP‐2 (PMID: 28973227). Hypothesis: ISP‐ and APG‐dependent vortex shedding frequency(VSF) lead to stalling of blood flow augment rapid onset of mortality by rupturing of cerebral vessels. Rationale: Impact of form drag on streamline bodies. Geometry: Part I: RBC, Platelets, WBC: detailed geometry of RBC, Platelets, WBC, p47‐56; Part II: Apr. Geo:, blood velocity, and function of human blood vessels, Table 2.1; 2,2; 2.3; p63; ISBN 9780128024089; Gov. Eq(s): Part A:Strouhal Number= St = fwD/V, where D is the characteristic length of Leucocyte, platelets, red blood cells (Bluff bodies @LPE –ZoO), fs=Vortex Shedding frequency, V=flow velocity; Part B: Drag Coefficient: Cd= 2Fd / ρu2A, where Fd is drag force‐velocity in the direction of flow, ρ = density of the fluid (blood @ hematocrit), u = flow speed, A=surface area of the vortices; Part C: Euler Equation with an assumption of inviscid, unsteady & irrotational flow: dP/ρ + ½ d (∇f2)+gdz=‐d(∂f/∂t), this eq for unsteady flow along streamline; where V=velocity elements; ∇, Del = gradient operator. Derivation from Eq 4.5 through 4.12, eq.4.9 is modified to yield eq. 4.12. (p187, ISBN: 9780071329194). CFD Simulations acknowledged with utmost gratitude and appreciation: Part I: Von Karman vortex street, by DolfynNet; https://www.youtube.com/watch?v=IDeGDFZSYo8&feature=youtu.be; https://youtu.be/f3LmjJ1N7YE; Part II: streamlines for 2 square obstructions by slffea CFD simulation of 2 square obstructions with streamlines (Source Ack: SLFCFD. https://www.youtube.com/watch?v=‐njBmpInmcU; Part III: Path lines for 2 square obstructions, Re = 1000. SLFCFD. https://www.youtube.com/watch?v=eAmJ4KOBVMQ; Part IV: Point Vortex Dynamics, https://www.youtube.com/watch?v=QiieaJFjQwM; Part V: Vortex Breakdown, FERGUL ‐ Fluids Engineering Research Group at the University of Liverpool. https://www.youtube.com/watch?v=b0TylIqcEsQ; Phys. Fluids 26, 053602 (2014); Part VI: CFD tutorial for Vortex Shedding, https://www.youtube.com/watch?v=cfjEMa2teVM; Derivation & Prospects:Taken together, the shear stress generated by VKVS@VSF, where velocity vector of the outside is upward and the opposite side is downward in a circular motion. ZoO vortices on the outside will be lifted up (upwash) and another side will be pushed down (downwash) of vortices past bluff bodies/ streamline bodies (ZoO vortices@LPE Aggregates‐Toxins of ClPr origin) with minimum effort ultimately degrade/rupture the glycocalyx‐endothelial surface downstream of the point of obstruction forming cerebral ischemia subsequently vasogenic edema stalling the flow. (PMID: 28973227). Such scenario may have been causing the rupture of cerebral arteries in turn hemorrhage, and irreversible loss of function, to CEP 100% ihm, in the usual care group in SSSP‐2 (PMID: 28973227).