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

Banerjee, A.; Aggarwal, Richa; Soni, Kapil Dev; Tirkha, Anjan

doi:10.1136/bcr-2019-233452

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Albumin administration has been shown to be helpful, presumably because of its ability to bind free fatty acids [ 1 , 2 ]. Steroid use has also been reported [ 5 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

A case of diffuse alveolar hemorrhage secondary to fat embolism after long bone fracture

Velloze

Holtrop

Adams

2022

Respiratory Medicine Case Reports

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“…Albumin administration has been shown to be helpful, presumably because of its ability to bind free fatty acids [ 1 , 2 ]. Steroid use has also been reported [ 5 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

A case of diffuse alveolar hemorrhage secondary to fat embolism after long bone fracture

Velloze

Holtrop

Adams

2022

Respiratory Medicine Case Reports

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“…Initial or mild FES is treated with supplemental oxygen, titrated to maintain normal PaO2. FES that progresses to respiratory failure requires mechanical ventilation [8,9]. Secondly, in patients exhibiting neurologic complications, neurologic status should be closely monitored via frequent Glasgow Coma Scale assessments and serial neurologic examinations.…”

Section: Discussionmentioning

confidence: 99%

Cerebral fat embolization with paroxysmal sympathetic hyperactivity syndrome and septic shock at high altitude: A case report and literature review

Zhu

Guo

et al. 2021

Preprint

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Background Cerebral fat embolism (CFE) syndrome at high altitude was rare complicated with paroxysmal sympathetic hyperactivity (PSH) syndrome and septic shock. It is a challenge to differential diagnosis and treatment at high altitude. Case presentation This case presents a CFE with PSH and septic shock of a 23-year-old man occurred at high altitude of 3800 meters above sea level, transferred by airplane successfully and cured in the department of neurosurgery, Xi`an Tangdu Hospital.Conclusions It is key that CFE with PSH can be rapid diagnosed and treatment bundles of septic shock should be initiated as soon as possible. Early neurological rehabilitation played an important role for good outcome.

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“…[ 2 ] The use of lung-protective ventilation and prone positioning is reported to help patients with ARDS caused by FES. [ 3 ] However, in FES cases with unstable pelvic fractures, comminuted vertebral fractures, or dislocated femoral fractures, it is necessary to achieve bone stability by performing early rigid internal fixation before placing the patient in the prone position. Numerous studies have shown that early definitive long bone fracture fixation is important in the prevention of respiratory complications.…”

Section: Introductionmentioning

confidence: 99%

Use of venovenous extracorporeal membrane oxygenation for perioperative management of acute respiratory distress syndrome caused by fat embolism syndrome

Momii

Shono²,

Osaki³

et al. 2021

Medicine

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Introduction: Fat embolism syndrome (FES) is a known complication of long bone fracture and can affect multiple organs. The organ most commonly affected with FES is the lung. Severe cases of FES from long bone fracture can cause acute respiratory distress syndrome (ARDS). Although the treatment of ARDS remains challenging, it is reported that a lung protection strategy and prone positioning are effective. In addition, early fixation is reported to be beneficial in respiratory failure due to FES, though it may exacerbate respiratory failure during the perioperative period. We report the use of venovenous extracorporeal membrane oxygenation (VV-ECMO) for the successful perioperative management of a patient diagnosed with ARDS due to FES. Patient concerns: A 24-year-old man injured in a traffic accident was brought to our emergency department due to shock and consciousness disorder. Diagnosis: After examining the patient, we noted bilateral pneumothorax, liver and spleen injuries, and multiple long bone fractures. Four days after admission, he was diagnosed with FES due to a prolonged consciousness disorder, progressive hypoxia with diffuse lung damage, and cutaneous and mucosal petechiae. Intervention: As respiratory failure progressed, VV-ECMO was initiated on the 6th day. To improve the respiratory failure caused by ARDS, prone position therapy was necessary. Thus, we performed osteosynthesis on the 9th day under ECMO. Prone position therapy was started after surgery. Outcomes: Subsequently, his respiratory condition and chest radiographs improved steadily. VV-ECMO was discontinued on the 17th day and the ventilator was removed on the 28th day. His consciousness levels improved without residual central nervous system complications. Conclusion: Our study reveals the successful improvement of FES-induced ARDS by osteosynthesis and prone positioning under VV-ECMO. This strategy prioritizes supportive treatment over pharmacologic interventions.

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

Cited by 5 publications

References 16 publications

A case of diffuse alveolar hemorrhage secondary to fat embolism after long bone fracture

A case of diffuse alveolar hemorrhage secondary to fat embolism after long bone fracture

Cerebral fat embolization with paroxysmal sympathetic hyperactivity syndrome and septic shock at high altitude: A case report and literature review

Use of venovenous extracorporeal membrane oxygenation for perioperative management of acute respiratory distress syndrome caused by fat embolism syndrome

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