Fat embolism syndrome natural history, complications and prognosis

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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

Fat embolism syndrome commonly occurs 12-24 hrs after the inciting event. It can occur as early as 12 hrs and as late as 2 weeks. Patients are often dyspneic, tachypneic and hypoxic. Complications of fat embolism syndrome include disseminated intravascular coagulation, right ventricular dysfunction, acute respiratory distress syndrome and shock. Most patients recover with supportive treatment. Mortality occurs in 5-15% of patients.

Natural History

Fat embolism syndrome commonly occurs 12-24 hrs after the inciting event. It can occur as early as 12 hrs and as late as 2 weeks. Patients are often dyspneic, tachypneic and hypoxic. if left untreated, patients can progress to develop the following features:

• 50% of patients with FES require mechanical ventilation
• Progression to adult respiratory distress syndrome (ARDS)
• Majority of patients develop neurologic abnormalities.
• Acute confusional state
• Coma
• Disseminated intravascular coagulation (DIC)
• Cardiogenic shock

Complications

The complications of fat embolism syndrome are as follows:

• Disseminated intravascular coagulation
• Right ventricular dysfunction
• Acute respiratory distress syndrome
• Shock
• Biventricular failure
• Death

Prognosis

The prognosis of fat embolism syndrome is as follows:

• Most patients recover spontaneously.
• With supportive care alone, the outcome of the disease is relatively better.
• Mortality occurs in 5-15% of patients.