Fat embolism syndrome medical therapy: Difference between revisions
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===Corticosteroids=== | ===Corticosteroids=== | ||
The rationale for administering steroids is based on the pro-inflammatory effect of fat [[embolism]]. They are used most commonly in the following patients: | The rationale for administering steroids is based on the pro-inflammatory effect of fat [[embolism]]. They are used most commonly in the following patients:<ref name="pmid16990062">{{cite journal| author=White T, Petrisor BA, Bhandari M| title=Prevention of fat embolism syndrome. | journal=Injury | year= 2006 | volume= 37 Suppl 4 | issue= | pages= S59-67 | pmid=16990062 | doi=10.1016/j.injury.2006.08.041 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16990062 }} </ref><ref name="pmid8196970">{{cite journal| author=Müller C, Rahn BA, Pfister U, Meinig RP| title=The incidence, pathogenesis, diagnosis, and treatment of fat embolism. | journal=Orthop Rev | year= 1994 | volume= 23 | issue= 2 | pages= 107-17 | pmid=8196970 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8196970 }} </ref> | ||
Those who have life-threatening complications of fat embolism syndrome such as: | Those who have life-threatening complications of fat embolism syndrome such as: | ||
* [[Respiratory failure]] | * [[Respiratory failure]] | ||
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'''(Contraindications):''' | '''(Contraindications):''' | ||
* Increased risk of [[infection]] | * Increased risk of [[infection]] | ||
===Fluid resuscitation=== | ===Fluid resuscitation=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Medical Therapy
The mainstay of treatment of fat embolism syndrome is supportive care, anticoagulation in some cases and corticosteroid therapy in severe respiratory distress. Following are the main steps followed for the management:[1][2]
Conservative management
The following conservative measures are taken to manage fat embolism syndrome:[3][2][4]
- In ICU supportive care
- Fluid resuscitation
- Supplemental oxygen
- Mechanical ventilation
- Intracranial monitoring and frequent neurological examination if central nervous system dysfunction is present.
In ICU supportive care
- Continuous monitoring of vital signs
- Neurological monitoring
- Daily CBCs
- Chest radiographs
- Echocardiogram
- CT scan
- Serial MRI scans
Supplemental oxygen
- High flow supplemental oxygen should be insued to maintain arterial oxygenation.[5]
Anticoagulation
The goals of anticoagulant therapy are as follows:
- It is administered only if the underlying cause is venous thromboembolism.
- Heparin stimulates the activity of lipase which accelerates the clearance of fat from the circulation.
Complications:
- Increased risk of hemorrhage
- Increased production of free fatty acids from fat break down
Contraindications:
- Pre-existing hematological diseases
- Trauma
Corticosteroids
The rationale for administering steroids is based on the pro-inflammatory effect of fat embolism. They are used most commonly in the following patients:[6][5] Those who have life-threatening complications of fat embolism syndrome such as:
Preferred regimen (1): Hydrocortisone 100 mg PO q8h daily for 5 days
Preferred regimen (2): Methylprednisone 1-1.5mg/kg/day for 5 days
(Contraindications):
- Increased risk of infection
Fluid resuscitation
The aims of fluid resuscitation are as follows:
- Maintaining intravascular volume
- Binding of fatty acids released into the circulation
- Decrease the lung injury
Albumin along with balanced electrolyte solution is recommended.
Mechanical ventilation:
Invasive or non-invasive mechanical ventilation is commonly used.
Mechanical cardiac support devices
- Used in patients with refractory shock
References
- ↑ Lindeque BG, Schoeman HS, Dommisse GF, Boeyens MC, Vlok AL (1987). "Fat embolism and the fat embolism syndrome. A double-blind therapeutic study". J Bone Joint Surg Br. 69 (1): 128–31. PMID 3818718.
- ↑ 2.0 2.1 Babalis GA, Yiannakopoulos CK, Karliaftis K, Antonogiannakis E (2004). "Prevention of posttraumatic hypoxaemia in isolated lower limb long bone fractures with a minimal prophylactic dose of corticosteroids". Injury. 35 (3): 309–17. PMID 15124801.
- ↑ Levy D (1990). "The fat embolism syndrome. A review". Clin Orthop Relat Res (261): 281–6. PMID 2245559.
- ↑ Cavallazzi R, Cavallazzi AC (2008). "[The effect of corticosteroids on the prevention of fat embolism syndrome after long bone fracture of the lower limbs: a systematic review and meta-analysis]". J Bras Pneumol. 34 (1): 34–41. PMID 18278374.
- ↑ 5.0 5.1 Müller C, Rahn BA, Pfister U, Meinig RP (1994). "The incidence, pathogenesis, diagnosis, and treatment of fat embolism". Orthop Rev. 23 (2): 107–17. PMID 8196970.
- ↑ White T, Petrisor BA, Bhandari M (2006). "Prevention of fat embolism syndrome". Injury. 37 Suppl 4: S59–67. doi:10.1016/j.injury.2006.08.041. PMID 16990062.