Supportive care of right ventricular failure due to fat embolism syndrome

Schwalbach, Kevin T.; Wade, Raymond; Mkorombindo, Takudzwa; McElwee, Sam K.; Wells, J Michael; Wille, Keith

doi:10.1016/j.rmcr.2021.101499

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Consequently, FES is linked to pulmonary hypertension, potentially causing RV dysfunction. 9 The biochemical theory states that released fat emboli degrade and produce toxic intermediates with proinflammatory effects, causing elevated levels of free fatty acids, phospholipase A2, and cytokines. 10,11 The production of proinflammatory lipid mediators could also explain the classic 24-72 h delay from the triggering event to clinically apparent symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanical theory suggests that fat globules cause vascular obstruction, similar to thrombotic emboli, leading to platelet activation, and fibrin deposition. Consequently, FES is linked to pulmonary hypertension, potentially causing RV dysfunction 9 . The biochemical theory states that released fat emboli degrade and produce toxic intermediates with proinflammatory effects, causing elevated levels of free fatty acids, phospholipase A2, and cytokines 10,11 .…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of fat embolism syndrome using point‐of‐care ultrasound

Cheong,

Avanzato,

Gómez

et al. 2023

Sonography

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Fat embolism (FES) is a condition that can lead to severe organ effects and death in patients with long bone fractures. Diagnosis is challenging due to multiple criteria. This case report presents the use of point‐of‐care ultrasound (POCUS) in diagnosing right ventricular dysfunction associated with fat embolism syndrome. A 36‐year‐old patient with a history of obesity presented with multiple fractures and respiratory failure after a road accident. Bedside echocardiography showed evidence of dilated right chambers, right ventricular outflow tract shortened acceleration time, and mild tricuspid insufficiency. Venous ultrasonography showed microembolic signals (MES) interpreted as fat embolism. The patient was treated with fracture reduction and osteosynthesis, which showed improvement in right ventricular dysfunction and the disappearance of MES. FES is a clinical syndrome that occurs after an identifiable bone injury. This case highlights the utility of POCUS in the diagnosis of FES.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis of fat embolism syndrome using point‐of‐care ultrasound

Cheong,

Avanzato,

Gómez

et al. 2023

Sonography

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“…In long bone fractures, such as femur fractures, the release of bone marrow and fat emboli into the bloodstream is a significant concern [6,7]. These emboli can travel to the pulmonary circulation, posing risks to pulmonary function and right ventricular (RV) performance [7,8]. The physiology of the RV, which handles lower pressures and is more compliant than the left ventricle, makes it particularly susceptible to increased strain from such embolic events [9].…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture

Kim,

Heo

2024

JPM

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Background: Femoral fractures often lead to complications such as altered pulmonary hemodynamics. Right ventricular global longitudinal strain (RV GLS), which correlates with pulmonary hemodynamics, indicates the subclinical function of the right ventricle (RV). This study aimed to investigate the predictive value of RV GLS for the risk of adverse clinical composite outcomes in patients with femoral fractures. Methods: Data were obtained from a prospective single-center cohort of patients hospitalized for femoral fractures and followed up for at least 1 year between March 2021 and October 2022. The primary outcome was the development of an adverse composite clinical event, which included pneumonia, pulmonary oedema or effusion, pulmonary thromboembolism, and all-cause mortality within the 1-year period following surgery. Results: Among the 163 patients, 36 (22.09%) experienced adverse composite clinical events during 1-year follow-up. The adverse outcome group demonstrated poorer RV GLS and RV free wall strain values than the non-adverse outcome group. The optimal cut-off value of RV GLS for predicting composite adverse clinical events was −12.55%. The cumulative composite event-free survival rate was significantly lower in the RV GLS ≥ −12.55% group (log-rank p-value = 0.003). After adjusting for confounding factors, multivariate Cox proportional hazards regression analyses showed that RV GLS ≥ −12.55% independently increased the risk of composite adverse clinical events by 2.65-fold. Conclusions: Poor RV GLS is a significant predictor of adverse clinical outcomes in patients with femoral fractures. Specifically, an RV GLS value of ≥ −12.55% indicated a substantially increased risk of adverse events.

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Fat embolism syndrome after humerus and pelvis fracture complicated by acute kidney injury requiring blood purification: a case report and literature review

Suda,

Fujii,

Asakura

et al. 2023

Ren Replace Ther

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Background Fat embolism syndrome (FES) is a rare syndrome that typically occurs 12–72 h after long bone or pelvic fractures with a classic triad of respiratory distress, neurologic changes, and petechial rash. Although Gurd’s criteria for FES include anuria or oliguria, the mechanism of acute kidney injury (AKI) remain unknown. Here, we present a case of FES complicated by AKI that required blood purification. Case presentation A 79-year-old woman was admitted to our hospital because of a right humerus and pelvic fracture caused by a traffic accident. On the second day of hospitalization, she developed impaired consciousness, respiratory failure, and disseminated intravascular coagulation (DIC). Chest radiography revealed bilateral diffuse alveolar infiltration. Brain magnetic resonance imaging revealed diffuse high signal intensity on diffusion-weighted imaging and diffuse low signal intensity on susceptibility-weighted imaging in the cerebral and cerebellar regions. The diagnosis of FES was confirmed and the patient was treated with methylprednisolone (40 mg/day) and ulinastatin. On the third day of hospitalization, she was admitted to our department because of AKI with oliguria. Although echocardiography showed an elevated right ventricular artery systolic pressure suggestive of pulmonary hypertension (PH), pulmonary congestion was initially considered on chest imaging, and hemodialysis and rapid ultrafiltration were initiated. However, she developed hypovolemic shock and treatment was switched to continuous hemodiafiltration and slow ultrafiltration. Thereafter, her consciousness, hypoxemia, DIC and PH completely improved. She was weaned from blood purification therapy on the 29th day of hospitalization. She had hemolytic anemia that might have been caused by thrombotic microangiopathy (TMA), but it resolved without plasmapheresis. On the 51st day of hospitalization, the patient was transferred to another hospital for rehabilitation. Conclusions FES can be complicated by AKI. In this case, DIC, which was difficult to differentiate from TMA, and/or renal congestion were considered to be a cause of AKI. Chest radiographs of FES may be indistinguishable from pulmonary congestion. In our case, chest radiography showed bilateral diffuse alveolar infiltrates which was not indicative of pulmonary congestion but pulmonary involvement of FES. FES is associated with PH, which may lead to right heart failure. Therefore, the patient could have developed hypovolemic shock due to hemodialysis and rapid ultrafiltration. Clinicians should pay attention to the hemodynamics when blood purification for FES is performed.

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Supportive care of right ventricular failure due to fat embolism syndrome

Cited by 3 publications

References 14 publications

Diagnosis of fat embolism syndrome using point‐of‐care ultrasound

Diagnosis of fat embolism syndrome using point‐of‐care ultrasound

Right Ventricular Subclinical Dysfunction as a Predictor of Postoperative Adverse Clinical Outcomes in Patients with Femoral Fracture

Fat embolism syndrome after humerus and pelvis fracture complicated by acute kidney injury requiring blood purification: a case report and literature review

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