Fat embolism syndrome medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

The mainstay of treatment of fat embolism syndrome is supportive care, anticoagulation in some cases and corticosteroid therapy in severe respiratory distress. The main steps followed in conservative management include in ICU supportive care, fluid resuscitation, supplemental oxygen, mechanical ventilation and intracranial monitoring.

The mainstay of treatment of fat embolism syndrome is supportive care, anticoagulation in some cases and corticosteroid therapy in severe respiratory distress. Following are the main steps followed for the management:^[1][2]

The following conservative measures are taken to manage fat embolism syndrome:^[3][4]

• In ICU supportive care
• Fluid resuscitation
• Supplemental oxygen
• Mechanical ventilation
• Intracranial monitoring and frequent neurological examination if central nervous system dysfunction is present.

• Continuous monitoring of vital signs
• Neurological monitoring
• Daily CBCs
• Chest radiographs
• Echocardiogram
• CT scan
• Serial MRI scans

• High flow supplemental oxygen should be insued to maintain arterial oxygenation.^[5]

The goals of anticoagulant therapy are as follows:

• It is administered only if the underlying cause is venous thromboembolism.
• Heparin stimulates the activity of lipase which accelerates the clearance of fat from the circulation.

Complications:

• Increased risk of hemorrhage
• Increased production of free fatty acids from fat break down

Contraindications:

• Pre-existing hematological diseases
• Trauma

The rationale for administering steroids is based on the pro-inflammatory effect of fat embolism. They are used most commonly in the following patients:^[6]

Those who have life-threatening complications of fat embolism syndrome such as:

• Respiratory failure
• Acute respiratory distress syndrome
• Shock

Preferred regimen (1): Hydrocortisone 100 mg PO q8h daily for 5 days

Preferred regimen (2): Methylprednisone 1-1.5mg/kg/day for 5 days

Contraindications:

• Increased risk of infection

The aims of fluid resuscitation are as follows:^[7][8]

• Maintaining intravascular volume
• Binding of fatty acids released into the circulation
• Decrease the lung injury

Albumin along with balanced electrolyte solution is recommended.

Invasive or non-invasive mechanical ventilation is commonly used.

• Used in patients with refractory shock