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    Patent Pending

    Blast Lung Injury Severity Score

    Stratifies primary blast lung injuries into three categories to guide ventilator treatment.

    INSTRUCTIONS

    Use in patients who have sustained blast injury and have respiratory symptoms (e.g. cough, cyanosis, dyspnea, hemoptysis).

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with respiratory symptoms after blast injury.

    • Primary blast injury (PBI) occurs when a blast wave accelerates and decelerates while traveling through tissues of varying density. Thus, PBI affects organs with greater air-tissue interfaces such as auditory, pulmonary, and gastrointestinal systems.
    • Primary blast lung injury (BLI) is radiological and clinical evidence of acute lung injury occurring after blast injury that is not due to secondary or tertiary blast injury. The pathophysiology is thought to be due to capillary rupture within alveoli leading to hemorrhage and pulmonary edema, which then reduce gas exchange, causing hypoxia and hypercarbia.
    • Clinical suspicion of primary BLI should be high after blast injury within an enclosed space, as the blast wave becomes amplified as it reflects off of the structural walls (Leibovici 1996).
    • Characteristic chest x-ray shows bilateral diffuse opacities in a “butterfly” pattern. Patients present with hypoxemia with associated pneumothoraces, bronchopleural fistulae, or hemoptysis.
    • In the studies, patients diagnosed with BLI were intubated immediately or within 2 hours of presentation due to respiratory decompensation. Thus, patients breathing spontaneously and adequately 2 hours after injury are unlikely to require mechanical ventilation because of BLI alone (Pizov et al 1999, Avidan et al 2005).
    • Useful in guiding triage decisions in the setting of mass casualties, determining ventilation treatment, and predicting outcomes.
    • BLI severity correlates with the likelihood of developing acute respiratory distress syndrome (ARDS), and can be helpful to delineate patients who will require more aggressive and potentially unconventional respiratory care (e.g. nitric oxide, high-frequency jet ventilation, independent lung ventilation, or extracorporeal membrane oxygenation).
    >200
    60 to 200
    <60
    Localized lung infiltrates
    Bilateral or unilateral lung infiltrates
    Massive bilateral lung infiltrates
    No
    Yes

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Reuven Pizov

    From the Creator

    Why did you develop the BLI Severity Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

    We developed BLI after analyzing results of victims from two explosions in close space. The severity of lung injury developed in purpose to adjust appropriate respiratory therapy in severely injured victims. 

    What pearls, pitfalls and/or tips do you have for users of the BLI Severity Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    The patients with high BLI required advance respiratory therapy. Regular conventional mechanical ventilation was not effective. 

    What recommendations do you have for doctors once they have applied the BLI Severity Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?

    We had a bad experience trying getting patient on cardiopulmonary bypass due to extensive intrapulmonary bleeding.

    How do you use the BLI Severity Score in your own clinical practice? Can you give an example of a scenario in which you use it?

    We used BLI to select patients required high frequency ventilation.

    About the Creator

    Reuven Pizov, MD, is a professor and chairman of anesthesiology and CCM at Hadassah Medical Center in Jerusalem, Israel. Dr. Pizov has authored several peer-reviewed studies in the field of anesthesiology.

    To view Dr. Reuven Pizov's publications, visit PubMed

    Are you Dr. Reuven Pizov? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Jennie Kim, MD
    Reviewed By
    • Travis Polk, MD, FACS
    About the Creator
    Dr. Reuven Pizov
    Are you Dr. Reuven Pizov?
    Partner Content
    Content Contributors
    • Jennie Kim, MD
    Reviewed By
    • Travis Polk, MD, FACS