Fat embolism syndrome medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
The mainstay of treatment of fat embolism syndrome is supportive care, anticoagulation in some cases and corticosteroid therapy in severe respiratory distress. | The mainstay of treatment of fat embolism syndrome is supportive care, [[Anticoagulant|anticoagulation]] in some cases and [[corticosteroid]] therapy in severe [[Respiratory system|respiratory]] distress. | ||
Following are the main steps followed for the management: | Following are the main steps followed for the management: | ||
===Conservative management=== | ===Conservative management=== | ||
*In ICU supportive care | *In ICU supportive care | ||
*Fluid resuscitation | *[[Fluid replacement|Fluid resuscitation]] | ||
*Supplemental oxygen | *Supplemental oxygen | ||
*Mechanical ventilation | *[[Mechanical ventilation]] | ||
*Intracranial monitoring and frequent neurological examination if central nervous system dysfunction is present. | *Intracranial monitoring and frequent [[Neurology|neurological]] examination if [[central nervous system]] dysfunction is present. | ||
===Supplemental oxygen=== | ===Supplemental oxygen=== | ||
* High flow supplemental oxygen should be insued to maintain arterial oxygenation. | * High flow supplemental [[oxygen]] should be insued to maintain [[Artery|arterial]] [[oxygenation]]. | ||
===Anticoagulation=== | ===Anticoagulation=== | ||
The goals of anticoagulant therapy are as follows: | The goals of [[anticoagulant]] therapy are as follows: | ||
* 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 [[Circulatory system|circulation]]. | ||
'''Complications:''' | '''Complications:''' | ||
* Increased risk of hemorrhage | * Increased risk of [[Bleeding|hemorrhage]] | ||
* Increased production of free fatty acids from fat break down | * Increased production of free fatty acids from fat break down | ||
'''Contraindications:''' | '''Contraindications:''' | ||
* Pre-existing hematological diseases | * Pre-existing [[Blood|hematological]] diseases | ||
* Trauma | * [[Physical trauma|Trauma]] | ||
===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: | ||
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]] | ||
* Acute respiratory distress syndrome | * [[Acute respiratory distress syndrome]] | ||
* Shock | * [[Shock]] | ||
Preferred regimen (1): Hydrocortisone 100 mg PO q8h daily for 5 days | Preferred regimen (1): [[Hydrocortisone]] 100 mg PO q8h daily for 5 days | ||
Preferred regimen (2): Methylprednisone 1-1.5mg/kg/day for 5 days | Preferred regimen (2): Methylprednisone 1-1.5mg/kg/day for 5 days | ||
'''(Contraindications):''' | '''(Contraindications):''' | ||
* Increased risk of infection | * Increased risk of [[infection]] | ||
===Fluid resuscitation=== | ===Fluid resuscitation=== | ||
The aims of fluid resuscitation are as follows: | The aims of fluid resuscitation are as follows: | ||
* Maintaining intravascular volume | * Maintaining intravascular [[volume]] | ||
* Binding of fatty acids released into the circulation | * Binding of fatty acids released into the circulation | ||
* Decrease the lung injury | * Decrease the [[lung]] injury | ||
Albumin along with balanced electrolyte solution is recommended. | [[Albumin]] along with balanced [[Electrolyte disturbance|electrolyte]] solution is recommended. | ||
===Mechanical ventilation:=== | ===Mechanical ventilation:=== | ||
Invasive or non-invasive mechanical ventilation is commonly used. | Invasive or non-invasive mechanical ventilation is commonly used. | ||
===Mechanical cardiac support devices=== | ===Mechanical cardiac support devices=== | ||
*Used in patients with refractory shock | *Used in patients with refractory [[shock]] | ||
==References== | ==References== | ||
Revision as of 19:30, 4 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
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:
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