Home
|
Inbox
|
Search
|
View Abstract
Acute Respiratory Distress Syndrome Secondary to Fat Embolism
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A5320 - Acute Respiratory Distress Syndrome Secondary to Fat Embolism
Author Block: A. J. Heckman1, S. Helgeson1, M. Kwon2, N. J. Patel1, N. M. Patel2, P. K. Guru2; 1Internal Medicine, Mayo Clinic, Jacksonville, FL, United States, 2Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States.
Introduction:
Acute Respiratory Distress Syndrome (ARDS) is responsible for significant morbidity and mortality in the current critical care practice. Knowledge of risk factors is essential. We describe a rare, challenging case of a syndrome causing ARDS.
Description:
A 53 year-old male with a past medical history of compensated cirrhosis, splenectomy, and hyperlipidemia underwent open reduction with internal fixation and intramedullary nailing of fractures to the right tibia, fibula, and rib 5 days after a fall. 48 hours after surgery, he experienced respiratory distress, hypoxemia, and somnolence that led to transfer to our facility. On arrival, he was confused and hypoxemic with a right lower extremity petechial rash. He had negative blood cultures, a normal procalcitonin level, and a normal echocardiogram. He required lung protective mechanical ventilation in the intensive care unit for ARDS. Chest x-ray and computed tomography (CT) of the chest showed diffuse ground glass opacities (GGOs) with interlobular septal thickening, and small pulmonary emboli. Bronchoscopy with bronchoalveolar lavage (BAL) was negative for viruses, bacteria, and fungi. Free fatty acid (FFA) levels were notably elevated. Based upon closed long bone fractures with delayed surgery, male sex, hypoxemia within 72 hours of surgery, somnolence, and a petechial rash, fat embolism syndrome (FES) was diagnosed. Despite supportive therapy for 2 weeks, barotrauma and refractory hypoxemia led to withdrawal of care per request of the family.
Discussion:
FES is a rare syndrome typically described after closed long bone fractures or orthopedic surgery. The diagnosis is challenging due to a non-specific clinical picture: a triad of hypoxemia, petechial rash, and cerebral dysfunction 48-72 hours after an inciting event. ARDS is a feared complication of FES. The pathogenesis of ARDS from FES is unclear. Embolization of fatty acids leading to capillary blockage and direct toxic lung injury are possible mechanisms of injury. FFA are frequently elevated. CT chest often shows bilateral GGOs, centrilobular nodules, and rarely, lobular consolidation or septal wall thickening as presented in our patient. Supportive care for ARDS to minimize lung damage from FES is vital. The role of corticosteroids and heparin is controversial. Early intervention for long bone fracture is a preventive strategy. A high index of suspicion in the post-operative period and awareness of the clinical and radiographic findings is helpful for appropriate care.
Author Block: A. J. Heckman1, S. Helgeson1, M. Kwon2, N. J. Patel1, N. M. Patel2, P. K. Guru2; 1Internal Medicine, Mayo Clinic, Jacksonville, FL, United States, 2Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States.
Introduction:
Acute Respiratory Distress Syndrome (ARDS) is responsible for significant morbidity and mortality in the current critical care practice. Knowledge of risk factors is essential. We describe a rare, challenging case of a syndrome causing ARDS.
Description:
A 53 year-old male with a past medical history of compensated cirrhosis, splenectomy, and hyperlipidemia underwent open reduction with internal fixation and intramedullary nailing of fractures to the right tibia, fibula, and rib 5 days after a fall. 48 hours after surgery, he experienced respiratory distress, hypoxemia, and somnolence that led to transfer to our facility. On arrival, he was confused and hypoxemic with a right lower extremity petechial rash. He had negative blood cultures, a normal procalcitonin level, and a normal echocardiogram. He required lung protective mechanical ventilation in the intensive care unit for ARDS. Chest x-ray and computed tomography (CT) of the chest showed diffuse ground glass opacities (GGOs) with interlobular septal thickening, and small pulmonary emboli. Bronchoscopy with bronchoalveolar lavage (BAL) was negative for viruses, bacteria, and fungi. Free fatty acid (FFA) levels were notably elevated. Based upon closed long bone fractures with delayed surgery, male sex, hypoxemia within 72 hours of surgery, somnolence, and a petechial rash, fat embolism syndrome (FES) was diagnosed. Despite supportive therapy for 2 weeks, barotrauma and refractory hypoxemia led to withdrawal of care per request of the family.
Discussion:
FES is a rare syndrome typically described after closed long bone fractures or orthopedic surgery. The diagnosis is challenging due to a non-specific clinical picture: a triad of hypoxemia, petechial rash, and cerebral dysfunction 48-72 hours after an inciting event. ARDS is a feared complication of FES. The pathogenesis of ARDS from FES is unclear. Embolization of fatty acids leading to capillary blockage and direct toxic lung injury are possible mechanisms of injury. FFA are frequently elevated. CT chest often shows bilateral GGOs, centrilobular nodules, and rarely, lobular consolidation or septal wall thickening as presented in our patient. Supportive care for ARDS to minimize lung damage from FES is vital. The role of corticosteroids and heparin is controversial. Early intervention for long bone fracture is a preventive strategy. A high index of suspicion in the post-operative period and awareness of the clinical and radiographic findings is helpful for appropriate care.
|
Home
|
Inbox
|
Search
|