Management of blast injuries and shock lung

Current Opinion in Anaesthesiology

Volumn 17, Issue 2, 2004, Pages 151-157

  Lavery, Gavin G ^a   Lowry, Ken G ^a  

^a ROYAL VICTORIA HOSPITAL   (United Kingdom)

Author keywords

Adrenal insufficiency; Blast lung; Damage control surgery; Lung protection; Selective digestive decontamination

Indexed keywords

ACTIVATED PROTEIN C; ANTIBIOTIC AGENT; ANTIOXIDANT; FATTY ACID; FLUDROCORTISONE; GLUCOCORTICOID; GLUTAMINE; HEMOGLOBIN; HYDROCORTISONE; STEROID;

ANTIMICROBIAL ACTIVITY; BAROTRAUMA; BIOPHYSICS; BLAST INJURY; BRADYCARDIA; CONTAMINATION; CRITICAL ILLNESS; ENVIRONMENTAL FACTOR; EXPLOSION; GLUCOSE BLOOD LEVEL; HISTOPATHOLOGY; HUMAN; HYPOTENSION; HYPOXEMIA; INFLAMMATION; INSULIN INFUSION; INTENSIVE CARE; LUNG INJURY; MULTIPLE ORGAN FAILURE; NUTRITION; OXIDATIVE STRESS; PRIORITY JOURNAL; REVIEW; SEPSIS; SHOCK LUNG;

EID: 2342438712     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001503-200404000-00011     Document Type: Review

References (76)

1. Guy RJ, Kirkman E, Watkins PE, Cooper GJ. Physiologic responses to primary blast. J Trauma 1998; 45:983-987.
2. Guy RJ, Watkins PE, Edmondstone WM. Electrocardiographic changes following primary blast injury to the thorax. J R Nav Med Serv 2000; 86:125-133.
3. Leibovici D, Gofrit ON, Stein M, et al. Blast injuries: bus versus open-air bombings - a comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma 1996; 41:1030-1035.
4. Hull JB, Bowyer GW, Cooper GJ, Crane J. Pattern of injury in those dying from traumatic amputation caused by bomb blast. Br J Surg 1994; 81:1132-1135.
5. Hull JB, Cooper GJ. Pattern and mechanism of traumatic amputation by explosive blast. J Trauma 1996; 40 (Suppl 3):S198-S205.
6. Stein M, Hirshberg A. Medical consequences of terrorism. The conventional weapon threat. Surg Clin North Am 1999; 79:1537-1552.
7. Elsayed NM. Toxicology of blast overpressure. Toxicology 1997; 121:1-15.
8. Elsayed NM, Gorbunov NV. Interplay between high energy impulse noise (blast) and antioxidants in the lung. Toxicology 2003; 189:63-74. This is an excellent review of original research on the direct effects of blast energy at tissue level.
9. Farmer JC, Jimenez EJ, Talmor DS, Zimmerman JL, editors. Fundamentals of Disaster Management. Des Plaines: Society of Critical Care Medicine; 2003. This publication contains 141 pages of practical information on all aspects of disaster management. It uses flow chart and action card format to provide information useful on-scene or in hospital for all types of disaster.
10. Advanced Trauma Life Support® (ATLS)®. 7th ed. Chicago: American College of Surgeons; 2003.
11. Irwin RJ, Lerner MR, Bealer JF, et al. Cardiopulmonary physiology of primary blast injury. J Trauma 1997; 43:650-655.
12. Irwin RJ, Lerner MR, Bealer JF, et al. Shock after blast wave injury is caused by a vagally mediated reflex. J Trauma. 1999; 47:105-110.
13. Tsokos M, Paulsen F, Petri S, et al. Histologic, immunohistochemical, and ultrastructural findings in human blast lung injury. Am J Respir Crit Care Med 2003; 168:549-555 This was an autopsy based study of eight cases exhibiting blast lung showing parenchymal haemorrhage and embolism of fat, bone marrow and air. The latter was not due to mechanical ventilation.
14. Rivers E, Nguyen B, Havstad S, et al. Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345:1368-1377.
15. Nicholas JM, Rix EP, Easley KA, et al. Changing patterns in the management of penetrating abdominal trauma: the more things change, the more they stay the same. J Trauma 2003; 55:1095-1108.
16. Johnson JW, Gracias VH, Schwab CW, et al. Evolution in damage control for exsanguinating penetrating abdominal injury. J Trauma 2001; 51:261-269.
17. Finlay IG, Edwards TJ, Lambert AW. Damage control laparotomy. Br J Surg 2004; 91:83-85. This was a small study of the damage control surgery approach in critically ill rather than trauma patients. It showed highly significant improvement in mortality when compared with that predicted by Portsmouth Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM).
18. Zuckerman S. Experimental study of blast injuries to the lungs. Lancet 1940; ii:224-226.
19. Falla ST. Effect of explosion-blast on the lungs: report of a case. Br Med J 1940; 2:255-256.
20. Mellor SG, Cooper GJ. An analysis of 828 servicemen killed or injured by explosions in Northern Ireland 1970-1984: the HACS statistics. Br J Surg 1989; 76:1006-1010.
21. Pizov R, Oppenheim-Eden A, Matot I, et al. Blast lung injury from an explosion on a civilian bus. Chest 1999; 115:165-172.
22. Sorkine P, Szold O, Kluger Y, et al. Permissive hypercapnia ventilation in patients with severe pulmonary blast injury. J Trauma 1998; 45:35-38.
23. Brower RG, Rubenfeld GD. Lung-protective ventilation strategies in acute lung injury. Crit Care Med 2003; 31:S312-S316. This is a review of randomized clinical trials of lung protection using conventional mechanical ventilators. It provides a good discussion of potential reasons for apparently different results.
24. Caseby NG, Porter MF. Blast injuries to the lungs: clinical presentation, management and course. Injury 1976; 1:1-12.
25. Mellor SG. The pathogenesis of blast injury and its management. Br J Hosp Med 1988; 39:536-539.
26. Hirshberg B, Oppenheimer-Eden A, Pizov R, et al. Recovery from blast lung injury. One year follow up. Chest 1999; 116:1683-1688.
27. Papini RP, Wilson AP, Steer JA, et al. Wound management in burn centres in the United Kingdom. Br J Surg 1995; 82:505-509.
28. Blair PHB, Rowlands BJ, Lowry KG, et al. Selective decontamination of the digestive tract. A stratified, randomised, prospective trial in a mixed ICU. Surgery 1991; 110:303-310.
29. Liberal A, D'Amico R, Pifferi S, et al. Antibiotics for preventing respiratory tract infections in adults receiving intensive care. Cochrane Database Syst Rev 2000; 2:CD000022.
30. De Jonge E, Schultz MJ, Spanjaard L, et al. Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 2003; 362:1011-1016. This large trial showed that selective digestive decontamination can decrease ICU and hospital mortality and, despite fears to the contrary, may reduce incidence of resistant Gram negative aerobic bacteria.
31. Leone M, Albanese J, Antonini F, et al. Long term (6-year) effect of selective digestive decontamination on antimicrobial resistance in intensive care, multiple-trauma patients. Crit Care Med 2003; 8:2239-2240. This describes a study in which subgroups of patients got selective digestive decontamination. There was no increase of methicillin resistance in Staphylococcus aureus but this did occur with Staphylococcus epidermidis.
32. Guidelines for the management of severe sepsis and septic shock. The International Sepsis Forum. Intensive Care Med 2001; 27 (Suppl 1): S1-S134.
33. Task Force of the American College of Critical Care Medicine Society of Critical Care Medicine. Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Crit Care Med 1999; 27:639-660.
34. Misset B, Timsit JF, Dumay MF, et al. A continuous quality-improvement program reduces nosocomial infection rates in the ICU. Intensive Care Med 2003; Dec 12 [Epub ahead of print]. This large single centre study showed benefit from infection control measures but that ventilator-associated pneumonia is different to urinary and venous catheter infection.
35. Harbarth S, Garbino J, Pugin J, et al. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003; 115:529-535.
36. Kollef MH. The importance of appropriate initial antibiotic therapy for hospital-acquired infections. Am J Med 2003; 115:582-584.
37. Yan SB, Helterbrand JD, Hartman DL, et al. Low levels of protein C are associated with poor outcomes in severe sepsis. Chest 2001; 120:915-922.
38. Mesters RM, Helterbrand J, Utterback BG, et al. Prognostic value of protein C concentrations in neutropenic patients at high risk of severe septic complications. Crit Care Med 2000; 28:2209-2216.
39. Taylor FB Jr, Chang A, Esmon CT, et al. Protein C prevents the coagulopathic and lethal effects of Escherichia coli infusion in the baboon. J Clin Invest 1987; 79:918-925.
40. Bernard GR, Vincent JL, Laterre PF, et al. Recombinant Human Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) Study Group: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344:699-709.
41. Cronin L, Cook DJ, Carlet J, et al. Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med 1995; 23:1430-1439.
42. Annane D, Sébille V, Troché G, et al. A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 2000; 283:1038-1045.
43. Beishuizen A, Thijs LG, Vermes I. Patterns of corticosteroid-binding globulin and the free cortisol index during septic shock and multitrauma. Intensive Care Med 2001; 27:1584-1591.
44. Koo DJ, Jackman D, Chaudry IH, Wang P. Adrenal insufficiency during the late stage of polymicrobial sepsis. Crit Care Med 2001; 29:618-622.
45. Briegel J, Forst H, Haller M, et al. Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blinded, single-center study. Crit Care Med 1999; 27:723-732.
46. Bollaert PE, Fieux F, Charpentier C, Levy B. Baseline cortisol levels, cortisol response to corticotropin, and prognosis in late septic shock. Shock 2003; 19:13-15. High baseline cortisol and poor basline cortisol are predictors of poor outcome. This study of 82 consecutive patients with septic shock confirmed messages from Annane et al. [42].
47. Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fluorocortisone on mortality in patients with septic shock. JAMA. 2002; 288:862-871.
48. Keh D, Boehnke T, Weber-Cartens S, et al. Immunologic and hemodynamic effects of "low-dose" hydrocortisone in septic shock: a double-blind, randomized, placebo-controlled, crossover study. Am J Respir Crit Care Med 2003; 167:512-520. This describes an excellent study design with crossover in 40 patients with septic shock. The use of hydrocortisone produced expected clinical effects while authors demonstrated parallel (perhaps causative) changes suggesting reduced nitric oxide production and inflammatory response.
49. Van den Berghe G, Wouters P, Weekers F, et al. Reactivation of pituitary hormone release and metabolic improvement by infusion of growth hormone-releasing peptide and thyrotropin-releasing hormone in patients with protracted critical illness. J Clin Endocrinol Metab 1999; 84:1311-1323.
50. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345:1359-1367.
51. Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med 2003; 31:359-366. These authors performed a reanalysis of the 2001 study population showing blood sugar control and that not insulin per se confers benefit.
52. Corwin HL, Surgenor SD, Gettinger A. Transfusion practice in the critically ill. Crit Care Med 2003; 31 (Suppl 12):S668-S671. This is a review of current practice and reasons for anaemia in critical illness.
53. Krafte-Jacobs B, Levetown ML, Bray GL, et al. Erythropoietin response to critical illness. Crit Care Med 1994; 22:821-826.
54. Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340:409-417.
55. Hebert PC, Yetisir E, Martin C, et al. Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 2001; 29:227-234.
56. Corwin HL, Gettinger A, Pearl RG, et al. The CRIT Study: Anemia and blood transfusion in the critically ill. Current clinical practice in the United States. Crit Care Med 2004; 32:39-52. This paper audits practice in 284 ICUs over 8 months. It shows apparently little attempt in general to apply restricted policies for transfusion. The number of units transfused is an independent predictor of worse clinical outcome.
57. Vincent JL, Baron JF, Reinhart K, et al. ABC (Anemia and Blood Transfusion in Critical Care) Investigators. Anemia and blood transfusion in critically ill patients. JAMA 2002; 288:1499-1507.
58. Corwin HL, Gettinger A, Pearl RG, et al. EPO Critical Care Trials Group. Efficacy of recombinant human erythropoietin in critically ill patients: a randomized controlled trial. JAMA 2002; 288:2827-2835.
59. Fowler RA, Berenson M. Blood conservation in the intensive care unit. Crit Care Med 2003; 31 (Suppl 12):S715-S720.
60. MacIsaac CM, Presneill JJ, Boyce CA, et al. The influence of a blood conserving device on anaemia in intensive care patients. Anaesth Intensive Care 2003; 31:653-657.
61. Thorpe S, Thomas AN. The use of a blood conservation pressure transducer system in critically ill patients. Anaesthesia 2000; 55:27-31.
62. Vincent JL, Abraham E, Annane D, et al. Reducing mortality in sepsis: new directions. Crit Care. 2002; 6 (Suppl 3):S1-S18. This describes a panel review of five studies giving an evidence base for changes in practice which includes detailed study protocols, further questions and panel recommendations based on each study.
63. Andel H, Kamolz LP, Horauf K, Zimpfer M. Nutrition and anabolic agents in burned patients. Burns 2003; 29:592-595.
64. Andrews FJ, Griffiths RD. Glutamine: essential for immune nutrition in the critically ill. Brit J Nutr 2002; 87:s3-s8.
65. Griffiths RD, Allen KD, Andrews FJ, Jones C. Infection, multiple organ failure, and survival in the intensive care unit: influence of glutamine-supplemented parenteral nutrition on acquired infection. Nutrition 2002; 18:546-552.
66. Jian ZM, Cao JD, Zhu XG, et al. The impact of alanyl-glutamine on clinical safety, nitrogen balance, intestinal permeability, and clinical outcome in postoperative patients: a randomized, double-blind, controlled study of 120 patients. J Parenter Enteral Nutr 1999; 23 (Suppl 5):S62-S66.
67. Garrel D, Patenaude J, Nedelec B, et al. Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: a prospective, controlled, randomized clinical trial. Crit Care Med 2003; 31:2444-2449. This study was performed in a single centre on 45 burns patients. There was a significant reduction in positive blood cultures and mortality with enteral glutamine.
68. Hall JC, Dobb G, Hall J, et al. A prospective randomized trial of enteral glutamine in critical illness. Intensive Care Med 2003; 10:1710-1716. This was a large long-term study with a good, blinded design. There was no evidence of benefit for enteral glutamine.
69. Gadek JE, DeMichele SJ, Karlstad MD, et al. Effect of enteral feeding with eicosapentaenoic acid, γ-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Crit Care Med 1999; 27:1409-1420.
70. ••] can be explained.
71. Weiss G, Meyer F, Matthies B, et al. Immunomodulation by perioperative administration of n-3 fatty acids. Br J Nutr 2002; 87:s89-s94.
72. Galban C, Montejo JC, Mesejo A, et al. An immune-enhancing diet reduces mortality rate and episodes of bacteremia in septic intensive care unit patients. Crit Care Med 2000; 28:643-648.
73. Bertolini G, Iapichino G, Radrizzani D, et al. Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med 2003; 29:834-840. This large study is the only one to date showing a negative effect of immunonutrition.
74. Heyland DK, Novak F, Drover JW, et al. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 2001; 286:944-953.
75. Beale RJ, Bryg DJ, Bihari DJ. Immunonutrition in the critically ill: a systematic review of clinical outcome. Crit Care Med 1999; 27:2799-2805.
76. Heys SD, Walker LG, Smith I, Eremin O. Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: a meta-analysis of randomized controlled clinical trials. Ann Surg 1999; 229:467-477.