Fat embolism syndrome medical therapy: Difference between revisions
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* It is administered only if the underlying cause is venous thromboembolism. | * 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. | * Heparin stimulates the activity of lipase which accelerates the clearance of fat from the circulation. | ||
Complications: | '''Complications:''' | ||
* Increased risk of hemorrhage | * Increased risk of hemorrhage | ||
* Increased production of free fatty acids from fat break down | * Increased production of free fatty acids from fat break down | ||
===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: | |||
Those who have life-threatening complications of fat embolism syndrome such as: | |||
* Respiratory failure | |||
* Acute respiratory distress syndrome | |||
* Shock | |||
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=== | ===Fluid resuscitation=== | ||
The aims of fluid resuscitation are as follows: | The aims of fluid resuscitation are as follows: | ||
| Line 35: | Line 48: | ||
Albumin along with balanced electrolyte solution is recommended. | Albumin along with balanced electrolyte solution is recommended. | ||
===Mechanical ventilation=== | ===Mechanical ventilation:=== | ||
Invasive or non-invasive mechanical ventilation is commonly used. | |||
==References== | ==References== | ||
Revision as of 23:10, 1 March 2018
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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:
Conservative management
- In ICU supportive care
- Fluid resuscitation
- Supplemental oxygen
- Mechanical ventilation
- Intracranial monitoring and frequent neurological examination if central nervous system dysfunction is present.
Supplemental oxygen
- High flow supplemental oxygen should be insued to maintain arterial oxygenation.
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
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:
Those who have life-threatening complications of fat embolism syndrome such as:
- Respiratory failure
- Acute respiratory distress syndrome
- Shock
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.