Síndrome da angústia respiratória do adulto por embolia gordurosa no período pós-operatório de lipoaspiração e lipoenxertia

Abstract

Fat embolism is defined as mechanical blockage of the vascular lumen by circulating fat globules. Although it primarily affects the lungs, it can also affect the central nervous system, retina, and skin. Fat embolism syndrome is a dysfunction of these organs caused by fat emboli. The most common causes of fat embolism and fat embolism syndrome are long bone fractures, although there are reports of its occurrence after cosmetic procedures. The diagnosis is made clinically, and treatment is still restricted to support measures. We report the case of a female patient who developed adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting. In this case, the patient responded well to alveolar recruitment maneuvers and protective mechanical ventilation. In addition, we present an epidemiological and pathophysiological analysis of fat embolism syndrome after cosmetic procedures. Keywords:Respiratory distress syndrome, adult; Embolism, fat; Lipectomy. ResumoA embolia gordurosa é definida como a ocorrência de bloqueio mecânico da luz vascular por gotículas circulantes de gordura. Acomete principalmente o pulmão, podendo afetar também o sistema nervoso central, a retina e a pele. A síndrome da embolia gordurosa é uma disfunção desses órgãos causada pelos êmbolos gordurosos. As causas mais comuns de embolia gordurosa e síndrome da embolia gordurosa são as fraturas de ossos longos, mas há relatos de sua ocorrência após procedimentos estéticos. O diagnóstico é clínico, e o tratamento ainda se restringe a medidas de suporte. Apresentamos o caso de uma paciente que evoluiu com síndrome da angústia respiratória do adulto por embolia gordurosa no período pós-operatório de lipoaspiração e lipoenxertia e respondeu bem às manobras de recrutamento alveolar e à ventilação mecânica protetora.Apresentamos também uma análise epidemiológica e fisiopatológica da síndrome da embolia gordurosa após procedimentos estéticos.Descritores: Síndrome do desconforto respiratório do adulto; Embolia gordurosa; Lipectomia.* Study carried out in the

Embolia gordurosa grave no peroperatório de lipoaspiração abdominal e lipoenxertia

“…O comprometimento neurológico e o maior número de órgãos acometidos indicam pior prognóstico da SEG. 15,16 …”

<p>Histopathological evaluation of autopsy cases with isolated pulmonary fat embolism (IPFE): is cardiopulmonary resuscitation a main cause of death in IPFE?</p>

“…Fat embolism (FE) is characterized by the presence of fat globules in the circulatory system. This situation is very common (47–100%), especially after long-bone fractures and in several other conditions, such as surgery, septicemia, sickle-cell anemia, parenteral lipid infusion, liposuction, pancreatitis, acute respiratory distress, osteomyelitis, fatty liver, and cardiopulmonary resuscitation (CPR) 1–5. The lungs, central nervous system, skin, and kidneys are the most frequently involved organs in FE, and mortality due to this complication is about 5–15% 6…”

Fat Embolism Syndrome: An Autopsy-Proven Case Involving a Patient on Dialysis and Systemic Scleroderma

“…Pulmonary fat emboli occur in more than 90% of patients with long-bone fractures,2 but the frequency of FES is reported to be between 0.9% and 11% following multiple bone fractures or lower long bone or pelvic fractures 2–4. Other conditions such as orthopedic surgery5 and liposuction for obesity6 have been reported as causes of FES. However, FES is very rare with vertebral body fractures7–9 despite their relatively high prevalence in the general population 10…”