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2005, Número 3

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Rev Inst Nal Enf Resp Mex 2005; 18 (3)


Embolia grasa: un síndrome clínico complejo

Santos MLE, Gotés PJ

Idioma: Español
Referencias bibliográficas: 60
Paginas: 230-239
Archivo PDF: 84.29 Kb.


RESUMEN

La embolia grasa describe la presencia de grasa en la circulación sanguínea asociada o no, al desarrollo de un síndrome de severidad variable e identificable por sus signos y síntomas. Puede ser secundaria a traumatismos, incluyendo cirugía ortopédica y estética, y a causas no traumáticas. Se han descrito diversas teorías para explicar el origen del émbolo y las manifestaciones sistémicas como la intravasación, la lipasa y los ácidos grasos libres, la embolia grasa de origen no traumático, la del choque y la coagulación. Las manifestaciones clínicas dependen del órgano o sistema afectado, habitualmente del aparato respiratorio, sistema nervioso central y hematológico. El diagnóstico se puede hacer mediante los criterios clínicos de Gurd y/o Lindeque. La determinación de grasa en sangre y orina carecen de sensibilidad, y la identificación de macrófagos alveolares con grasa depende de una muestra adecuada de lavado broncoalveolar; la tomografía de alta resolución y la resonancia magnética nuclear son promisorias para demostrar la entidad. El tratamiento es de soporte y no específico. El uso de esteroides ha producido disminución de la mortalidad en la mayoría de estudios, pero si se requiere de ventilación mecánica, la mortalidad se incrementa. En cirugía ortopédica y traumatológica es posible prevenir el evento, y en general, evitando la hipoxemia, hipotensión y la deshidratación perioperatoria y postraumática.


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