Abstract: Objective To elaborate on the diagnosis and treatment of blast injury of the lungs in extensively burned patients. Methods The clinical data of 16 patients with blast injury of the lungs and extensive burns were analyzed. Results The clinical manifestations of blast injury of the lungs were observed 7-10 days after the injury, with variable manifestations in chest X-ray. Five patients developed acute respiratory distress syndrome, and all the patients experienced pulmonary infection. Fourteen cases were finally cured, and 2 died of severe blast injury of the lungs and severe systemic infection. The burns healed well in all the surviving patients. Conclusions These patients often have delayed onset of clinical manifestation, severe symptoms of long duration, with high rate of pulmonary infection and pleural effusions, and variable manifestations in chest X-ray easily confused with pulmonary infections. Attention should be given to management of multiorgan dysfunction syndrome and adequate transfusion. Low tide volume lung-protective ventilation strategy and lung recruitment measures may prove beneficial. Prevention and management of ventilator-associated pneumonia, pulmonary infection and wound infection, along with improvement of microcirculation, organ function protection and intensive nutrition support, are effective treatments for patients with blast injury of the lungs and extensive burns.