![]() ![]() The Blast Lung Injury (BLI) Severity Score is useful in guiding triage decisions in the setting of mass casualties, determining ventilation treatment, and predicting outcomes. Thus, patients breathing spontaneously and adequately 2 hours after injury are unlikely to require mechanical ventilation because of BLI alone (Pizov 1999, Avidan 2005). In the studies, patients diagnosed with BLI were intubated immediately or within 2 hours of presentation due to respiratory decompensation. Patients present with hypoxemia with associated pneumothoraces, bronchopleural fistulae, or hemoptysis. The pathophysiology is thought to be due to capillary rupture within alveoli leading to hemorrhage and pulmonary edema, which then reduces gas exchange, causing hypoxia and hypercarbia.Ĭlinical 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).Ī characteristic chest x-ray shows bilateral diffuse opacities in a “butterfly” pattern. 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. ![]() Thus, PBI affects organs with greater air-tissue interfaces such as auditory, pulmonary, and gastrointestinal systems. Primary blast injury (PBI) occurs when a blast wave accelerates and decelerates while traveling through tissues of varying density. Front teeth-to-carina distance in children undergoing cardiac catheterization. ![]() Hunyady AI, Pieters B, Johnston TA, et al. Assessment of airway length of Korean adults and children for otolaryngology and ophthalmic surgery using a fiberoptic bronchoscope. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. 2005 88(12):1838-1846.Īcute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Estimation of the proper length of orotracheal intubation by Chula formula. Techanivate A, Kumwilaisak K, Samranrean S. The average of the 3 scores (Pak, Hunyady, and Chula) is nearly identical to the Chula formula. Pak et al in 2010 and Hunyady et al in 2008 developed similar assessments of optimal ETT placement. The upper border of the ETT cuff was always > 1.9 cm below the vocal cords, avoiding risk of laryngeal trauma or inadvertent extubation. No patient was at immediate risk of endobronchial intubation. The distance between the ETT and carina ranged between 1.9-7.5 cm. Subsequently, a bronchoscope was used to determine the relationship among the ETT, carina, and vocal cords. Patients were intubated and the ETT placed according to the formula. The authors prospectively validated the use of this formula among 100 patients in Thailand. The Chula formula was developed and validated by Techanivate et al (2005) at King Chulalongkorn Memorial Hospital in Thailand. Obtain chest radiograph and measurement of CO 2 level (eg, end-tidal CO 2 or blood gas analysis) to confirm ETT position and adequacy of ventilation. University of Vermont, Burlington, VT Critical Actions Usual tidal volume target = 6-8 mL/kg IBW Use in adult patients (aged > 20 years) requiring orotracheal intubation.ĮTT position should still be verified with a chest radiograph for patients who will remain intubated for an extended period of time.įor tidal volume, 6 to 8 mL/kg ideal body weight is generally a safe initial setting, but further ventilator adjustment may be required, depending on the adequacy of ventilation and airway pressures.Ĭhula formula: ETT depth = 0.1 * + 4 Use of lower tidal volumes appears to prevent the development of acute respiratory distress syndrome, even in patients who do not have lung injury. Standard approaches to verify ETT depth (eg, bilateral auscultation) are insensitive. However, placing the ETT too shallow may risk injury to the vocal cords and accidental extubation. Placing the ETT too deep may cause right mainstem intubation, hypoxemia, and pneumothorax.
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