Primary blast lung injury - a review

Abstract

Bomb or explosion-blast injuries are likely to be increasingly encountered as terrorist activity increases and pre-hospital medical care improves. We therefore reviewed the epidemiology, pathophysiology and treatment of primary blast lung injury. In addition to contemporary military publications and expert recommendation, an EMBASE and MEDLINE search of English speaking journals was undertaken using the medical subject headings (MeSHs) ‘blast injury’ and ‘lung injury’. Review articles, retrospective case series, and controlled animal modelling studies published since 2000 were evaluated. 6-11% of military casualties in recent conflicts have suffered primary blast lung injury but the incidence increases to more than 90% in terrorist attacks occurring in enclosed spaces such as trains. The majority of victims require mechanical ventilation and intensive care management. Specific therapies do not exist and treatment is supportive utilizing current best practice. Understanding the consequences and supportive therapies available to treat primary blast lung injury are important for anaesthetists.

Microstructural Consequences of Blast Lung Injury Characterized with Digital Volume Correlation

“…It is difficult to quantify at this stage how this focal injury may progress, but this process is certainly a possibility. BLI has been reported to exhibit non-visible lung damage soon after blast but, over a period of 24-48 hours, it may progress toward a critical and lifethreatening injury (Scott et al, 2017). Potentially the augmentation of structural mechanics reported here plays a role in the degradation of the tissue, alongside the resulting physiological consequences.…”

“…This collection of work is not the norm in terms of experimental numbers, which typically range from 20 to 200 per study; animal models range from pigs (large) (Garner et al, 2010) down to mice (small) (Kohsuke et al, 2016). While much research focuses on global effects of trauma, which contributes significantly to knowledge of patient outcome, lung injuries actually range from diffuse and sparse regions of visible tissue damage to non-detectable damage (by conventional imaging techniques) (Scott et al, 2017).…”

Protection of the lung from blast overpressure by stress wave decouplers, buffer plates or sandwich panels

“…The latter is likely a consequence of penetrating projectiles or secondary blast effects. That research has led to advances in the treatment of those with both blast and haemorrhage 20. It may be time to re-evaluate the benefits of blast overpressure protection of the lungs and the metrics used; not in isolation but with a view to understanding how such technology could potentially ‘decouple’ some of the physiological interactions of those subjected to both blast overpressure and fragment insults.…”

Damage-Associated Molecular Patterns and Their Signaling Pathways in Primary Blast Lung Injury: New Research Progress and Future Directions

“…Gas expands rapidly from the explosion point and displaces the surrounding medium to create a blast overpressure (BOP), which transfers a large amount of energy to the surrounding medium to form the blast pressure wave [ 3 ]. Generally speaking, blast injuries can be divided into 4 categories, including primary (injury from direct effect of blast pressure wave), secondary (fragmentation injury), tertiary (injury caused by bodily displacement or building collapse) and quaternary (includes burn injury and inhalation of toxic substances) [ 3 , 4 , 5 , 6 , 7 ]. Furthermore, some research proposed quinary injuries, but the specific content has not reached a consensus [ 3 , 5 , 6 , 8 ].…”