Blast lung injury: clinical manifestations, treatment, and outcome

Avidan, Vered; Hersch, Moshe; Armon, Yaron; Spira, Ram; Aharoni, Dvora; Reissman, Petachia; Schecter, William P.

doi:10.1016/j.amjsurg.2005.08.022

« Previous Next »The American Journal of Surgery
Volume 190, Issue 6 , Pages 945-950, December 2005

Blast lung injury: clinical manifestations, treatment, and outcome

Presented at the 57th Annual Meeting of the Southwestern Surgical Congress, San Antonio, Texas, April 10–12, 2005

Vered Avidan, M.D.
- Department of Surgery, Sharee Zedek Medical Center, Jerusalem, Israel
Moshe Hersch, M.D., M.Sc.
- Department of Anesthesiology and Intensive Care, Sharee Zedek Medical Center, Jerusalem, Israel
Yaron Armon, M.D.
- Department of Surgery, Sharee Zedek Medical Center, Jerusalem, Israel
Ram Spira, M.D.
- Department of Surgery, Sharee Zedek Medical Center, Jerusalem, Israel
Dvora Aharoni, M.D.
- Department of Radiology, Sharee Zedek Medical Center, Jerusalem, Israel
Petachia Reissman, M.D. (F.A.C.S.)
- Department of Surgery, Sharee Zedek Medical Center, Jerusalem, Israel
William P. Schecter, M.D. (F.A.C.S.)
- Department of Surgery, Sharee Zedek Medical Center, Jerusalem, Israel
- Department of Surgery, University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, 3A33, San Francisco, CA 94110, USA
- Corresponding author. Tel.: +1-415-206-4626; fax: +1-415-206-5484.

Received 8 April 2005; received in revised form 8 August 2005

Abstract

Background

Blast lung injury (BLI) is a major cause of morbidity after terrorist bomb attacks (TBAs) and is seen with increasing frequency worldwide. Yet, many surgeons and intensivists have little experience treating BLI. Jerusalem sustained 31 TBAs since 1983, resulting in a local expertise in treating BLI.

Methods

A retrospective study of clinical and radiologic characteristics, management, and outcome of victims of TBAs sustaining BLI who were admitted to ICU during December 1983 to February 2004. Long-term outcome was determined by a telephone interview.

Results

Twenty-nine patients met inclusion criteria. Hypoxia and pulmonary infiltrates in chest x-ray were sine qua non for the diagnosis. Seventy-six percent required mechanical ventilation, all within 2 hours of admission. One patient died. Seventy-six percent had no long-term sequelae.

Conclusions

Most patients with significant BLI injury require mechanical ventilation. Late deterioration is rare. Death because of BLI in patients who survived the explosion is unusual. Timely diagnosis and correct treatment result in excellent outcome.

Keywords: Blast injury , Acute lung injury , Barotrauma , Explosions