Des emboles de graisse au syndrome d'embolie graisseuse

Estèbe, Jean Pierre

doi:10.1016/s0750-7658(97)87195-x

Cited by 32 publications

(73 citation statements)

References 99 publications

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“…The "Fat Embolism" is defined as the occurrence of a mechanical blockage of vascular light caused by circulating droplets of fat with diameters exceeding 8 to 10u, usually getting trapped in the capillary meshwork. In addition to fat, those emboli also often carry hematopoietic cell of the bone marrow, which confirms its origin (7)(8)(9)(10)(11) . Because the FE is initially a venous phenomenon, it is natural and expected that lungs are not only their first target, but also the most affected organs.…”

Section: Introductionmentioning

confidence: 58%

“…3rd) Through the inter-atrial septum, by the "Oval Foramen". Recent studies using the transesophageal echocardiography (TE-ECO), have demonstrated that in about 20 to 34% of adult individuals from a normal population, this foramen is patent (6,8,(14)(15)(16)(17) . It was also noticed that, even in individuals in whom this foramen was closed, it could be opened by the occurrence of acute pulmonary hypertension such as those that may occur in a massive FE (5,6,8) .…”

Section: Introductionmentioning

confidence: 99%

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Embolia gordurosa: uma revisão para a prática ortopédica atual

et al. 2005

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A embolia gordurosa (EG) é a oclusão de pequenos vasos por gotículas de gordura, geralmente originadas nas fraturas do fêmur, tíbia e bacia, e nas artroplastias do joelho e quadril. Normalmente não causa danos aos órgãos atingidos, a menos que seja maciça. Em poucos casos a EG evolui para a "síndrome da embolia gordurosa" (SEG) a qual afeta principalmente os pulmões e o cérebro, embora qualquer órgão ou estrutura do organismo possa ser afetada. A gordura embolizada é hidrolizada pela lipase, originando os ácidos graxos livres (AGL) que agem toxicamente sobre o endotélio capilar e que intensificam a ação das integrinas as quais acentuam a adesividade dos neutrófilos às células endoteliais, facilitando a ação das enzimas proteolíticas dos lisossomas desses neutrófilos sobre o endótelio. O resultado dessas reações é a ruptura da rede capilar seguida de hemorragia e edema nos órgãos afetados. A SEG apresenta desde insuficiência respiratória e alterações neurológicas variadas até convulsões e coma profundo. O diagnóstico da SEG é puramente clínico, não existindo nenhum exame laboratorial que o confirme. Dentre os exames de imagens, apenas a ressonância magnética cerebral demonstra claramente as áreas do edema perivascular e dos infartos. O tratamento da EG com inúmeras drogas não apresentou resultados positivos; no entanto, a medida mais requisitada para a SEG é a assistência ventilatória. A mortalidade é quase de 100% nas formas fulminantes; aproximadamente de 20% nas formas sub-agudas e não há mortalidade na forma sub-clínica. Para prevenir a SEG é fundamental evitar o choque e a hipóxia desde a cena do acidente, e proceder à fixação precoce das fraturas, o que diminui a incidência de SARA e a mortalidade pós-trauma.

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Section: Introductionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Embolia gordurosa: uma revisão para a prática ortopédica atual

et al. 2005

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“…They appear after an interval of 12-96 h of the inciting trauma and are usually seen around the axillae, neck and over the sternum. Though reported to have a frequency of 25-95%,[47] these should not be confused with DIC, prolonged hypoxia and repeated blood transfusion.…”

Section: Introductionmentioning

confidence: 99%

Fat embolism syndrome

George

Dixit

et al. 2013

Lung India

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Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. Presenting in a wide range of clinical signs of varying severity, fat embolism is usually diagnosed by a physician who keeps a high degree of suspicion. The clinical background, chronology of symptoms and corroborative laboratory findings are instrumental in a diagnosis of fat embolism syndrome. There are a few diagnostic criteria which are helpful in making a diagnosis of fat embolism syndrome. Management is mainly prevention of fat embolism syndrome, and organ supportive care. Except in fulminant fat embolism syndrome, the prognosis is usually good.

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“…Mortality rates between 14 and 87% were reported in FES occurred in polytrauma cases. [2425] Early fixation of fractures and modern ICU care has decreased the incidence of FES to be less than 10%. [2627]…”

Section: Discussionmentioning

confidence: 99%

Analyzing fat embolism syndrome in trauma patients at AIIMS Apex Trauma Center, New Delhi, India

Gupta

D’souza

Sawhney

et al. 2011

J Emerg Trauma Shock

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Background:Fat embolism syndrome (FES) is a constellation of symptoms and signs subsequent to orthopedic trauma.Materials and Methods:The clinical profile of FES in the trauma population was studied over 2 years and 8 months.Results:The incidence of FES among all patients with long bone and pelvic fractures was 0.7% (12). The mean injury severity score was 10.37 (SD 1.69) (range 9-14). The diagnosis of FES was made by clinical and laboratory criteria. Hypoxia was the commonest presentation (92%). The average days of onset of symptoms were 3.5 (SD1.29) days. Management included ventilator support in 75%, average ventilator days being 7.8 (SD 4.08) days. The average ICU stay and hospital stay were 9.1 days and 29.7 days, respectively. A mortality of 8.3% (1) was observed.Conclusion:Fat embolism remains a diagnosis of exclusion and is a clinical dilemma. Clinically apparent FES is unusual and needs high index of suspicion, especially in long bone and pelvic fractures.

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Des emboles de graisse au syndrome d'embolie graisseuse

Cited by 32 publications

References 99 publications

Embolia gordurosa: uma revisão para a prática ortopédica atual

Embolia gordurosa: uma revisão para a prática ortopédica atual

Fat embolism syndrome

Analyzing fat embolism syndrome in trauma patients at AIIMS Apex Trauma Center, New Delhi, India

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