Resuscitation and trauma anesthesiaManagement of blast injuries and shock lungLavery, Gavin Ga; Lowry, Ken Gb Author Information aCritical Care Services and bAnaesthesia, Theatres and Intensive Care, Royal Hospitals Trust, Belfast, Northern Ireland, UK Correspondence to Dr G.G. Lavery, MD, FCA.RCSI, Director, Critical Care Services, Royal Hospitals Trust, Belfast, BT12 6BA, Northern Ireland, UK Tel +44 2890 633286; fax:+44 2890 236167; e-mail: [email protected] Abbreviations ABC: airways-breathing-circulation EGDT: early goal-directed therapy ICU: intensive care unit SIRS: systemic inflammatory response syndrome Current Opinion in Anaesthesiology 17(2):p 151-157, April 2004. Buy Abstract Purpose of review Blast injuries have always occurred both in civilian life and as acts of war or terrorism. Nowadays, the risk of being involved in an explosion has increased even for those living in countries with no previous experience of such events. It is our intention that this review is of assistance to those providing emergency/critical care to patients who have sustained blast injuries. Recent findings Exposure to blast may indirectly produce physiological insults such as bradycardia, hypotension, tissue hypoxia and oxidative stress. The use of early goal-directed therapy might be important in minimizing such insults. Explosions in an enclosed environment are associated with increased risk of pulmonary blast injury and also air and fat embolism. Mechanical ventilation after pulmonary blast injury is associated with barotrauma and the use of lung protective strategies previously recommended in acute lung injury may be beneficial. Summary The potential for blast to cause injury depends on the nature of the explosive and environment in which the blast occurs. Soft tissue injury with environmental contamination is frequent. Optimal antimicrobial cover and strategies such as selective digestive decontamination may be advantageous. Early surgery should follow the principles of ‘damage control’. Blast injury often leads to severe sepsis/systemic inflammatory response, multiple organ dysfunction and prolonged critical illness. In this clinical scenario, recent studies have shown improved outcome with the use of activated protein C, steroid replacement and aggressive control of blood glucose but have been less convincing regarding the use of immunonutrition. © 2004 Lippincott Williams & Wilkins, Inc.