Blast lung injury: clinical manifestations, treatment, and outcome.
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.
Avidan
Vered
V
Department of Surgery, Sharee Zedek Medical Center, Jerusalem, Israel.
Hersch
Moshe
M
Armon
Yaron
Y
Spira
Ram
R
Aharoni
Dvora
D
Reissman
Petachia
P
Schecter
William P
WP
D000293:Adolescent; D000328:Adult; D000368:Aged; D001753:Blast Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005107:Explosions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000401:mortality / Q000628:therapy; D007442:Intubation, Intratracheal; D007902:Length of Stay; D055370:Lung Injury; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D013902:Radiography, Thoracic; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D023481:Terrorism; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D016896:Treatment Outcome