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PubMed1979

The use of methylprednisolone and hypertonic glucose in the prophylaxis of fat embolism syndrome.

In a prospective randomized trial of prophylactic therapy in fat embolism syndrome (FES) 64 patients with femoral and/or tibial shaft fractures uncomplicated by other significant injuries were treated with hypertonic glucose (A), methylprednisolone (B), and placebo (C). Clinical findings and several laboratory parameters were used to establish the diagnosis. Two of the 23 patients in the placebo group (C), 3 of the 21 patients in the hypertonic dextrose (A) group and none of the 20 patients in the methylprednisolone (B) group developed clinical fat embolism syndrome. All patients with fat embolism syndrome were hypoxemic (pO2 less than 65 mm Hg) and exhibited central nervous system symptoms. Four out of 5 were hypocalcemic and 3 patients had thrombocytopenia. There was a high incidence of subclinical hypoxemia or subclinical fat embolism syndrome (29% in A Group, 15% in B Group and 39% in C Group). A comparison between groups of the mean pO2 for each patient demonstrated a statistically significant difference between the methylprednisolone group and the control group (p less than 0.025) as was the comparison of proportions of pO2 less than 70 mm Hg (methylprednisolone versus control p less than 0.01, glucose versus control p less than 0.03). Methylprednisolone given prophylactically may reduce the incidence of fat embolism syndrome and can reduce the degree of hypoxemia associated with long bone fractures of the lower extremmity.

Adult↗
PubMed2001

Cerebral fat embolism after a nondisplaced tibial fracture: case report.

Fat embolism syndrome has been observed after traumatic or nontraumatic events. In traumatic cases, fat embolism syndrome is known to occur in patients with a fracture of a long bone. The case of a patient with a cerebral fat embolism associated with a nondisplaced fracture of the tibial shaft is reported.

Adult↗
PubMed1977

Fat embolism syndrome: a puzzling phenomenon.

Fat emboli are a life-threatening source of respiratory insufficiency. Whether they are of mechanical or chemical origin remains a subject of controversy. Fat embolism syndrome is most often seen after fracture of long bones, and immobilization of the fracture site may decrease risk of its development. Adequate oxygenation is the most important aspect of therapy; most patients given vigorous supportive treatment recover with no residual lung injury.

Embolism, Fat↗
PubMed1977

[Thoracic injury and fat embolism].

The authors state that fat embolism occurs rather frequently following thoracic injuries. It is difficult to make a diagnosis because of the complexity of the symptoms. The correct evaluation of the characteristic clinical and laboratory signs arising after a period free of symptoms is essential. The authors outline the brief case history of a successfully treated patient, who recovered, owing to the use of the respirator in the intensive care unit.

Adult↗
PubMed1994

Specificity of bronchoalveolar lavage for the diagnosis of fat embolism syndrome.

The diagnosis of fat embolism syndrome (FES) is relatively difficult because simple, quantitative criteria have been lacking. The results of a recent study, however, suggest that the diagnosis of FES can be made if more than 5 per cent of the cells in fluid obtained by bronchoalveolar lavage are lipid-laden. Our study was designed to assess the specificity of this lipid staining test of bronchoalveolar cells for diagnosing FES in a series of patients coming to the pulmonology clinic. Thirty-four consecutive patients with suspected pulmonary diseases, but not FES, underwent routine bronchoscopy. Bronchoalveolar fluid was applied to slides, fixed with formalin, and stained with oil red 0. Three hundred consecutive cells of each specimen were observed for red-staining droplets. More than 5 per cent of bronchoalveolar lavage cells stained for lipids in 25 of the 34 subjects. The calculated specificity, assuming a negative finding is defined as < or = 5 per cent lipid-laden cells in the sample, was 26.5 per cent. We conclude that staining of bronchoalveolar lavage cells for lipids is not a specific test for FES.

Bronchoalveolar Lavage Fluid↗
PubMed2001

Intraosseous infusion and pulmonary fat embolism.

OBJECTIVES: To determine the incidence of pulmonary fat embolism after the intraosseous (IO) infusion of normal saline and drugs and to determine whether pulmonary capillary blood is a predictor of lung fat embolism. DESIGN: A randomized, prospective, animal study. SETTING: Animal research laboratory of a university hospital. SUBJECTS: Twenty-eight mixed breed piglets (average weight 30.9 kg). Interventions and Methods: Animals were anesthetized, intubated, mechanically ventilated, and instrumented. IO needles were placed in the tibial bone. Animals were assigned to one of four groups: Group 1 received fluid (20 mL/kg) under 300 mm Hg pressure (n = 6); group 2 received fluid (20 mL/kg) at free flow under gravity (n = 6); group 3 received 100 mL of fluid over 20 mins (n = 8); and group 4 received 100 mL of fluid over 7 mins (n = 8). MEASUREMENTS AND MAIN RESULTS: Buffy coat samples were obtained from pulmonary arterial catheter in the occluded position at baseline, after IO needle placement, and at the end of infusion. Lung specimens (both upper and lower lobes) were obtained at the end of the infusion. Specimens were stained with oil red O and graded for fat emboli by a pathologist blinded to experimental conditions. Fat emboli (one to three emboli per high power field) were found in about 30% of the lung specimens. The difference in number of fat emboli between groups was not statistically significant. Buffy coat stains yielded fat emboli, which were distributed sporadically in all groups. CONCLUSION: Fat embolism is common; however, the method of IO fluid administration does not influence the number of emboli. Our study therefore implies that the risk of fat embolization is of concern, but its clinical relevance is unclear. Until the clinical significance of pulmonary fat emboli and the prevalence of fat emboli syndrome are delineated more precisely, the IO route is an effective but not necessarily safe route for delivery of fluids and drugs.

Journal Article↗