Blast Lung Injury Severity Score
INSTRUCTIONS
Use in patients who have sustained blast injury and have respiratory symptoms (e.g. cough, cyanosis, dyspnea, hemoptysis).
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).
Result:
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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
- Jennie Kim, MD
