Blast Lung Injury From an Explosion on a Civilian Bus

• Published in: Chest Vol. 115; no. 1; pp. 165 - 172
• Main Authors: Pizov, Reuven, Oppenheim-Eden, Arieh, Matot, Idit, Weiss, Yoram G., Eidelman, Leonid A., Rivkind, Avraham I., Sprung, Charles L.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.01.1999; American College of Chest Physicians
• Subjects: Adolescent; Adult; ARDS; Biological and medical sciences; Blast Injuries - classification; Blast Injuries - diagnosis; Blast Injuries - etiology; Blast Injuries - mortality; blast trauma; Explosions; Fatalities; Female; Foreign Bodies - classification; Foreign Bodies - diagnosis; Foreign Bodies - etiology; Foreign Bodies - mortality; high-frequency jet ventilation; Humans; Hypoxia - classification; Hypoxia - diagnosis; Hypoxia - etiology; Hypoxia - mortality; Injuries; Injuries of the thorax. Foreign bodies. Diseases due to physical agents; Injury Severity Score; Israel; lung barotrauma; Lung Injury; Male; mechanical ventilation; Medical sciences; Middle Aged; Motor Vehicles; Nitric oxide; Patients; Pneumothorax; Pneumothorax - classification; Pneumothorax - diagnosis; Pneumothorax - etiology; Pneumothorax - mortality; Prognosis; Respiratory Distress Syndrome, Adult - classification; Respiratory Distress Syndrome, Adult - diagnosis; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Retrospective Studies; Survival Rate; Trauma; Traumas. Diseases due to physical agents; Tropical medicine; Ventilators; Jerusalem Israel; Israel; nitric oxide; mechanical ventilation; PEEP; high-frequency jet ventilation; Fio2; blast trauma; HFJV; lung barotrauma; PPV; PCIRV; ARDS; ALI; BLI; Human; Lung disease; Bus; Blast trauma; Prognosis; Respiratory disease; Exploration; Trauma; Bronchopulmonary; Symptomatology; Clinical management; Treatment; Classification; Bronchus disease; Severity score; Diagnosis; Collective transport system
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.115.1.165

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. Retrospective analysis. Fifteen patients with primary BLI resulting from explosions on two civilian buses in 1996. 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/Fio2ratio), 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). 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.