Schwalbach KT, Wade RC, Mkorombindo T, McElwee SK, Wells JM, Wille KM. Supportive care of right ventricular failure due to fat embolism syndrome.
Respir Med Case Rep 2021;
34:101499. [PMID:
34485049 PMCID:
PMC8403578 DOI:
10.1016/j.rmcr.2021.101499]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/11/2021] [Accepted: 08/24/2021] [Indexed: 11/14/2022] Open
Abstract
Pulmonary fat embolism is a common phenomenon in cases of traumatic long bone fractures, with only a minority developing the more catastrophic Fat Embolism Syndrome (FES). Diagnosis is clinical and requires a high index of suspicion. Treatment remains under-investigated, with common interventions having low quality level-of-evidence and no mortality benefit. In severe cases, focus should be on supporting the failing right ventricle through use of inotropes, pulmonary vasodilators, and mechanical circulatory support. This requires a thorough understanding of the unique physiology through the pulmonary circulation.
Pulmonary fat embolism is a common phenomenon following long bone fracture. Only a minority develop the more serious complication Fat Embolism Syndrome (FES).
FES is a diagnosis of exclusion classically characterized by hypoxemia, altered mentation, and petechiae. Mortality is often a result of right ventricular (RV) failure.
The failing RV has unique physiology. Treatment focuses on supportive care through use of inotropes, pulmonary vasodilators, and mechanical circulatory devices.
Collapse