Inhaled Nitric Oxide as Rescue Therapy in Near Fatal Fat Embolism Syndrome

Miyai, Tomio; Ayala, Estela; Ravindranath, Krithi; Chung, Jeanette W.; Hill, Shana; Kagawa, Frank T.; Kirsch, Carl M.; Jensen, William A.; Wehner, John H.; Mohindra, Vibha; Hsiao, Eric; Namath, Allen; Gregor, Peter; Allo, Maria D.; Sherck, John P.

doi:10.1378/chest.10963

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“…There is very little evidence in the literature of NO therapy used in patients with FES who developed ARDS. Two studies [ 12 , 13 ] reported successfully administering inhaled NO in the setting of acute RV failure that developed after massive fat embolism. In Case 1 , a 33-year-old man with FES complicated by severe RV systolic pressure (75 mm Hg) responded well to inhaled NO [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two studies [ 12 , 13 ] reported successfully administering inhaled NO in the setting of acute RV failure that developed after massive fat embolism. In Case 1 , a 33-year-old man with FES complicated by severe RV systolic pressure (75 mm Hg) responded well to inhaled NO [ 12 ]. In Case 2 , a 19-month-old girl with severe refractory hypoxemia on FiO 2 of 1.0 and significant hemodynamic compromise (dopamine and norepinephrine infusion) caused by acute fat embolism improved with inhaled NO therapy after failing to improve with high frequency mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

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Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure

Brotfain

Koyfman

Kutz

et al. 2014

Case Reports in Critical Care

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Fat embolism syndrome (FES) is a life-threatening condition in which multiorgan dysfunction manifests 48–72 hours after long bone or pelvis fractures. Right ventricular (RV) failure, especially in the setting of pulmonary hypertension, is a frequent feature of FES. We report our experience treating 2 young, previously healthy trauma patients who developed severe hypoxemia in the setting of FES. Neither patient had evidence of RV dysfunction on echocardiogram. The patients were treated with inhaled nitric oxide (NO), and their oxygenation significantly improved over the subsequent few days. Neither patient developed any cardiovascular compromise. Patients with FES that have severe hypoxemia and evidence of adult respiratory distress syndrome (ARDS) are likely at risk for developing RV failure. We recommend that these patients with FES and severe refractory hypoxemia should be treated with inhaled NO therapy prior to the onset of RV dysfunction.

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Section: Discussionmentioning

confidence: 99%