0
Clinical Investigations in Critical Care |

Blast Lung Injury From an Explosion on a Civilian Bus*

Reuven Pizov, MD; Arieh Oppenheim-Eden, MD; Idit Matot, MD; Yoram G. Weiss, MD; Leonid A. Eidelman, MD; Avraham I. Rivkind, MD; Charles L. Sprung, MD, FCCP
Author and Funding Information

*From the Department of Anesthesiology and Critical Care Medicine (Drs. Pizov, Oppenheim-Eden, Matot, Weiss, Eidelman, and Sprung), and Trauma Unit (Dr. Rivkind), Department of Surgery, Hadassah University Medical Center, The Hebrew University of Jerusalem, Israel.



Chest. 1999;115(1):165-172. doi:10.1378/chest.115.1.165
Text Size: A A A
Published online

Objective: To assess clinical signs and management of primary blast lung injury (BLI) from explosions in an enclosed space and to propose a BLI severity scoring system.

Design:Retrospective analysis.

Patients: Fifteen patients with primary BLI resulting from explosions on two civilian buses in 1996.

Results: Ten patients were extremely hypoxemic on admission (Pao2 < 65 mm Hg with oxygen supplementation). Four patients remained severely hypoxemic (Pao2/fraction of inspired oxygen (Fio2) ratio of < 60 mm Hg) after mechanical ventilation was established and pneumothoraces were drained. Initial chest radiographs revealed bilateral lung opacities of various sizes in 12 patients (80%). Seven patients (47%) had bilateral pneumothoraces and two patients had a unilateral pneumothorax. Five (33%) had clinically significant bronchopleural fistulae. After clinical and laboratory data were collected, a BLI severity score was defined based on hypoxemia (Pao2/Fio2 ratio), chest radiographic abnormalities, and barotrauma. Severe BLI was defined as a Pao2/Fio2 ratio of< 60 mm Hg, bilateral lung infiltrates, and bronchopleural fistula; moderate BLI as a Pao2/Fio2 ratio of 60 to 200 mm Hg and diffuse (bilateral/unilateral) lung infiltrates with or without pneumothorax; and mild BLI as a Pao2/Fio2 ratio of> 200, localized lung infiltrates, and no pneumothorax. Five patients developed ARDS with Murray scores > 2.5. Respiratory management included positive pressure ventilation in the majority of the patients and unconventional methods (ie, high-frequency jet ventilation, independent lung ventilation, nitric oxide, and extracorporeal membrane oxygenation) in patients with severe BLI. Of the four patients who had severe BLI, three died. All six patients with moderate BLI survived, and four of five with mild BLI survived (one with head injury died).

Conclusions: BLI can cause severe hypoxemia, which can be improved significantly with aggressive treatment.The lung damage may be accurately estimated in the early hours after injury. The BLI severity score may be helpful in determining patient management and prediction of final outcome.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Conference Summary*: Acute Lung Injury
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543