‘Low-dose’ Corticosteroid Prophylaxis against Fat Embolism

Kallenbach, J; Lewis, Michael I.; Zaltzman, M; Feldman, Charles; Orford, A; S, Zwi

doi:10.1097/00005373-198710000-00013

Cited by 71 publications

(41 citation statements)

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“…Studies reporting beneficial effects [5,31,82,83] used doses of methyl prednisolone between 9 mg.kg 21 and 90 mg.kg 21 (in divided doses). The results of these trials were impressive, with a 10-fold reduction of FES in one series; however, the only fatality reported in any of these trials was due to overwhelming sepsis in a patient receiving corticosteroids [30]. All these randomised controlled trials report significant decreases in FES, although only three [5,30,82] reported significantly improved gas exchange.…”

Section: Treatmentmentioning

confidence: 98%

“…The results of these trials were impressive, with a 10-fold reduction of FES in one series; however, the only fatality reported in any of these trials was due to overwhelming sepsis in a patient receiving corticosteroids [30]. All these randomised controlled trials report significant decreases in FES, although only three [5,30,82] reported significantly improved gas exchange. The numbers of patients treated are small, ranging between 10 and 40 in the treatment groups, and factors including temperature and white cell count, which would be altered by corticosteroids themselves, were used as indicators of FES.…”

Section: Treatmentmentioning

confidence: 98%

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Fat embolism

2001

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SummaryFat embolism syndrome is a collection of respiratory, haematological, neurological and cutaneous symptoms and signs associated with trauma and other disparate surgical and medical conditions. The incidence of the clinical syndrome is low (, 1% in retrospective reviews) whilst the embolisation of marrow fat appears to be an almost inevitable consequence of long bone fractures. There is debate over the pathogenesis of fat embolism syndrome and it seems a variety of factors interact to produce a spectrum of end organ damage. Many therapeutic interventions and prophylactic strategies have been tried with varying success. Current treatments are supportive and the condition is usually associated with a good outcome. The literature on fat embolism syndrome is extensive and this review aims to discuss the incidence, aetiology, pathophysiology, diagnosis and treatment of fat embolism.

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Section: Treatmentmentioning

confidence: 98%

Section: Treatmentmentioning

confidence: 98%

Fat embolism

2001

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“…The emphasis remains on prevention with modified surgical techniques, corticosteroid therapy in high risk patients, and intravascular volume replacement in all patients. [15][16][17] This case report demonstrates the importance of including FES in the differential diagnosis of acute postoperative neurological dysfunction. Unfortunately, even if FES is recognized in a monitored setting as we have described, there are limited means of prevention or effective treatment.…”

Section: Discussionmentioning

confidence: 92%

Case report: Acute postoperative neurological impairment from fat embolism syndrome

McIntyre

French

Rose

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: To describe a case of fat embolism syndrome (FES) following elective tendon contracture release in a patient with myotonic dystrophy, to highlight the importance of considering this entity in the differential diagnosis of acute postoperative neurocognitive dysfunction. Clinical features:A 34-yr-old man with myotonic dystrophy underwent uneventful tendon contracture release under regional anesthesia. In the immediate postoperative period, neurological and respiratory complications developed, requiring intensive care support. The patient showed the classical clinical triad of hypoxemia, neurological impairment and a petechial rash associated with the FES. A diagnosis of FES was made and, despite therapy including fluid and inotropic support, the patient succumbed to the condition. There was no demonstrated intracardiac shunt, suggesting a physiological intrapulmonary shunt was responsible for the development of systemic manifestations of FES. Conclusions:Postoperative neurological dysfunction is a difficult condition with numerous possible causes. All possible etiologies, including FES, need to be considered in the differential diagnosis and postoperative management of patients developing acute postoperative neurological impairment and hypoxemia. U NRESOLVING postoperative neurocognitive dysfunction is a serious complication following surgery. The acute postoperative period is a critical time when significant neurological changes can be difficult to detect, and as a result of multiple potential etiologies and contributing factors, diagnosis and appropriate management can sometimes be delayed. We present a case of acute postoperative neurological dysfunction resulting from fat embolism syndrome 296 CAN J ANESTH 54: 4 www.cja-jca

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“…Limitations Limitations 1 -With the exception of a 2004 article, the other six studies were more than 20 years old [6][7][8] . 2 -The number of patients included in this metaanalysis was small (389), which was split into two groups and originating from few prospective and randomized studies.…”

Section: Limitations Limitations Limitationsmentioning

confidence: 99%

Uso de corticoide na profilaxia para síndrome de embolia gordurosa em pacientes com fratura de osso longo

Silva

Carmona

Calderan

et al. 2013

Rev. Col. Bras. Cir.

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The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture TBE-CITE TBE-CITE TBE-CITE TBE-CITE TBE-CITEThe use of corticosteroid for the prophylaxis of fat embolism The use of corticosteroid for the prophylaxis of fat embolism The use of corticosteroid for the prophylaxis of fat embolism The use of corticosteroid for the prophylaxis of fat embolism The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture syndrome in patients with long bone fracture syndrome in patients with long bone fracture syndrome in patients with long bone fracture syndrome in patients with long bone fracture Uso de corticoide na profilaxia para síndrome de embolia gordurosa em Uso de corticoide na profilaxia para síndrome de embolia gordurosa em Uso de corticoide na profilaxia para síndrome de embolia gordurosa em Uso de corticoide na profilaxia para síndrome de embolia gordurosa em Uso de corticoide na profilaxia para síndrome de embolia gordurosa em pacientes pacientes pacientes pacientes pacientes com fratura de osso longo com fratura de osso longo com fratura de osso longo com fratura de osso longo com fratura de osso longo The "Evidence-based Telemedicine -Trauma & Acute Care Surgery" (EBT-TACS) Journal Club conducted a critical review of the literature and selected three recent studies on the use of corticosteroids for the prophylaxis of fat embolism syndrome (FES). The review focused on the potential role of corticosteroids administration to patients admitted to the intensive care unit (ICU) at risk of developing post-traumatic fat embolism. The first study was prospective and aimed at identifying reliable predictors, which could be detected early and were associated with the onset of fat embolism syndrome in trauma patients. The second manuscript was a literature review on the role of corticosteroids as a prophylactic measure for FES. The last manuscript was a meta-analysis on the potential for corticosteroids to prophylactically reduce the risk of fat embolism syndrome in patients with long bone fractures. The main conclusions and recommendations reached were that traumatized patients should be monitored with non-invasive pulse oximetry and lactate levels since these commonly-available tests may predict the development of FES, and the lack of evidence to recommend the use of steroids for the prophylaxis of this syndrome.

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‘Low-dose’ Corticosteroid Prophylaxis against Fat Embolism

Cited by 71 publications

References 0 publications

Fat embolism

Fat embolism

Case report: Acute postoperative neurological impairment from fat embolism syndrome

Uso de corticoide na profilaxia para síndrome de embolia gordurosa em pacientes com fratura de osso longo

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