Clinical characteristics and management of patients with fat embolism syndrome in level I Apex Trauma Centre

Abstract

Purpose Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months. Methods In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed. Results We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit. Conclusion FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral.

<p>Extremely Acute-Onset Cerebral Fat Embolism</p>

“…However, almost all the cases were reversible and had good neurological recovery. 1,2,[4][5][6][7][8][9]22 In contrast, the previously reported patients with acute-onset CFE 3,18,19 as well as our patient exhibited poor neurological outcomes, raising the possibility that the rapid onset of CFE might be a peculiar risk factor for worse neurological outcomes. Future studies and further education of trauma physicians are necessary for the diagnosis of CFE to improve prognosis.…”

“…Fat embolism syndrome (FES) is a potentially fatal complication and develops most frequently after long bone fractures [1][2][3][4][5][6] and usually presents 24-72 h after the injury, with an average time of 48.5 h from injury to symptom presentation. 1 FES is diagnosed clinically by respiratory distress, neurological impairment, and petechial rash.…”

“…The majority of case reports on CFE report that cerebral dysfunction associated with CFE is reversible. 1,2,[4][5][6][7][8][9] The risk factors for FES are young age, multiple closed long bone fractures, crush injury, and conservative therapy for fractures or delayed stabilization. [10][11][12] We herein present the rare case of CFE that occurred in <1 h after the injury with no obvious risk factor and was associated with a poor neurological outcome.…”

“…A typical case of FES has a latency period of 24-72 h, with an average of 48.5 h, after the injury, 1 whereas the most recent study reported that FES manifested between 16 h and 7 days, with an average of 56 h, after the insult. 2 Our review of the literature identified only three cases of FES with a latency period of less than 3 h 3,18,19 (Table 1).…”

Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

“…The most common presentation of fat embolism includes respiratory distress and severe hypoxaemia in 92%–100% of patients,6–8 with requirement for mechanical ventilation in 44%–66% of cases of FES with long bone fracture 3 8. In our case, the diagnosis of FES was made on the basis of Gurd’s criteria,9 with signs of respiratory insufficiency, decreased mental status and presence of petechial rashes as the major criteria, and tachycardia, anaemia and retinal haemorrhage as minor criteria.…”