Critical Care and Shock

Fat Embolism Syndrome

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The classical syndrome of fat embolism is characterized by the triad of respiratory failure, neurologic dysfunction and the presence of a petechial rash. Fat embolism syndrome (FES) occurs most commonly following orthopedic trauma, particularly fractures of the pelvis or long bones, however non-traumatic fat embolism has also been known to occur on rare occasions. Because no definitive consensus on diagnostic criteria exist, the accurate assessment of incidence, comparative research and outcome assessment is difficult. A reasonable estimate of incidence in patients after long bone or pelvic fractures appears to be about 3-5%. The FES therefore remains an important cause of morbidity and mortality and warrants further investigation and research to allow proper recognition as well as the development of preventive and therapeutic strategies. Early fracture fixation is likely to reduce the incidence of fat embolism syndrome and pulmonary complications; however the best fixation technique remains controversial.
The use of prophylactic corticosteroids may be considered to reduce the incidence of FES and in selected high-risk trauma patients but effects on outcome are not proved. New reaming and venting techniques have potential to reduce the incidence of FES during arthroplasty. Unfortunately, no specific therapies have been proven to be of benefit in FES and treatment remains supportive with priority being given to the maintenance of adequate oxygenation.


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