Fat embolism syndrome medical therapy

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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

The mainstay of treatment of fat embolism syndrome is supportive care, anticoagulation in some cases and corticosteroid therapy in severe respiratory distress. The main steps followed in conservative management include in ICU supportive care, fluid resuscitation, supplemental oxygen, mechanical ventilation and intracranial monitoring.

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][4]

In ICU supportive care

Supplemental oxygen

Anticoagulation

The goals of anticoagulant therapy are as follows:

Complications:

  • Increased risk of hemorrhage
  • Increased production of free fatty acids from fat break down

Contraindications:

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]

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:

Fluid resuscitation

The aims of fluid resuscitation are as follows:[7][8]

  • 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

  1. 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. 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.
  3. Levy D (1990). "The fat embolism syndrome. A review". Clin Orthop Relat Res (261): 281–6. PMID 2245559.
  4. 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. 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.
  6. 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.
  7. Shaikh N (2009). "Emergency management of fat embolism syndrome". J Emerg Trauma Shock. 2 (1): 29–33. doi:10.4103/0974-2700.44680. PMC 2700578. PMID 19561953.
  8. Habashi NM, Andrews PL, Scalea TM (2006). "Therapeutic aspects of fat embolism syndrome". Injury. 37 Suppl 4: S68–73. doi:10.1016/j.injury.2006.08.042. PMID 16990063.

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