medigraphic.com
A partir del año 2010, la Revista Oficial del INER cambió a NCT (Neumología y Cirugía de Tórax)

 Ver actualización

2005, Number 3

<< Back Next >>

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

Fat embolism: a complex clinic syndrome

Santos MLE, Gotés PJ

Language: Spanish
References: 60
Page: 230-239
PDF size: 84.29 Kb.


ABSTRACT

Fat embolism (FE) describes the presence of fat globules in the circulation. It may be associated with a clinical syndrome (FES) that can be readily identified by its signs and symptoms. It may follow traumatic events such as orthopedic or cosmetic surgery, or non-traumatic events. Diverse theories try to explain the origin of FE and the FES, such as intravasation, lipase and free fatty acids, FE of non-traumatic origin, and one of shock and coagulation. The clinical manifestations vary from mild to severe and include the respiratory, central nervous, dermatologic and hematologic systems. Diagnosis may be established following Gurd and/or Lindeque’s clinical criteria. Fat determination in blood and urine lacks sensitivity; bronchoalveolar lavage to determine the presence of fat depends on an adequate sample of alveolar macrophages. High resolution thoracic tomography and nuclear magnetic resonance of the brain can be helpful. Treatment is only palliative and non-specific. In most studies, steroids have decreased mortality, but if ventilatory support is needed, the mortality rate increases. Prevention is possible during orthopedic and trauma surgery; hypoxemia, hypotension, and perioperative and post-traumatic dehydration should be avoided.


REFERENCES

  1. . Peltier LF. Fat embolism: a perspective. Clin Orthop Relat Res 2004;422:148-153.

  2. Mellor A, Soni N. Fat embolism. Anaesthesia 2001;56:145-154.

  3. Robert JH, Hoffmeyer P, Broquet PE, Cerutti P, Vasey H. Fat embolism syndrome. Orthop Rev 1993;22:567-571.

  4. Parisi DM, Koval K, Egol K. Fat embolism syndrome. Am J Orthop 2002;31:507-512.

  5. Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome. A 10-year review. Arch Surg 1997;132:435-439.

  6. Cardenas-Camarena L. Lipoaspiration and its complications: a safe operation. Plast Reconstr Surg 2003;112:1435-1441.

  7. Grazer FM, de Jong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast Reconstr Surg 2000;105;436-446.

  8. Hulman G. Pathogenesis of non-traumatic fat embolism. Lancet 1988;1:1366-1367.

  9. Robinson CM. Current concepts of respiratory insufficiency syndromes after fracture. J Bone Joint Surg Br 2001;83:781-791.

  10. Foex P. Right ventricular function during ARDS. Acta Anaesthesiol Scand Suppl 1991;95:72-79.

  11. Rautanen M, Gullichsen E, Riutta A, et al. Experimental fat embolism induces urine 2,3-dinor-6-ketoprostaglandin F1 alpha and 11-dehydrothromboxane B2 excretion in pigs. Crit Care Med 1997;25:1215-1221.

  12. Nakata Y, Tanaka H, Kuwagata Y, Yoshioka T, Sugimoto H. Triolein-induced pulmonary embolization and increased microvascular permeability in isolated perfused rat lungs. J Trauma 1999;47:111-119.

  13. Wheelwright EF, Byrick RJ, Wigglesworth DF, et al. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism. J Bone Joint Surg Br 1993;75:715-723.

  14. Hofmann S, Huemer G, Salzer M. Pathophysiology and management of the fat embolism syndrome. Anaesthesia 1998;52 Suppl 2:35-37.

  15. Riseborough EJ, Herndon JH. Alterations in pulmonary function, coagulation and fat metabolism in patients with fractures of the lower limbs. Clin Orthop Relat Res 1976;115:248-267.

  16. Fourme T, Vieillard-Baron A, Loubieres Y, Julie C, Page B, Jardin F. Early fat embolism after liposuction. Anesthesiology 1998;89:782-784.

  17. Mitaka C, Hirata Y, Habuka K, et al. Atrial natriuretic peptide improves pulmonary gas exchange by reducing extravascular lung water in canine model with oleic acid-induced pulmonary edema. Crit Care Med 2002;30:1570-1575.

  18. Rowe IF, Soutar AK, Trayner IM, Thompson GR, Pepys MB. Circulating human C-reactive protein binds very low density lipoproteins. Clin Exp Immunol 1984;58:237-244.

  19. Pepys MB. C-reactive protein fifty years on. Lancet 1981;1:653-657.

  20. Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing. Injury 1993;24 Suppl 3:73-81.

  21. Levy D. The fat embolism syndrome. Clin Orthop Relat Res 1990;(261):281-286.

  22. McDermott ID, Culpan P, Clancy M, Dooley JF. The role of rehydration in the prevention of fat embolism syndrome. Injury 2002;33:757-759.

  23. Blow O, Magliore L, Claridge JA, Butler K, Young JS. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma 1999; 47:964-970.

  24. Byrick RJ, Mullen JB, Mazer CD, Guest CB. Transpulmonar systemic fat embolism. Studies in mongrel dogs after cemented arthroplasty. Am J Respir Crit Care Med 1994;150(5 Pt 1):1416-1422.

  25. Faist E, Schinkel C, Zimmer S. Update on the mechanisms of immune suppression of injury and immune modulation. World J Surg 1996;20:454-459.

  26. Piantadosi CA, Schwartz DA. The acute respiratory distress syndrome. Ann Intern Med 2004;141:460-470.

  27. Ochoa GFJ, Saralegui RI, Fernández EV, Fernández MME. Síndrome de embolia grasa. Emergencias 1998;2:123-125.

  28. Santos-Martínez LE, Pulido T, Bautista E, et al. Síndrome de embolia grasa secundaria a inyección intramuscular de material oleoso. Rev Inst Nal Enf Resp Mex 2004;17:272-279.

  29. Chastre J, Basset F, Viau F, et al. Acute pneumonitis after subcutaneous injections of silicone in transsexual men. N Engl J Med 1983;308:764-767.

  30. Maitre B, Habibi A, Roudot-Thoraval F, et al. Acute chest syndrome in adults with sickle cell disease. Chest 2000;117:1386-1392.

  31. Uzun O, Findik S, Danaci M, Katar D, Erkan L. Pulmonary and cerebral oil embolism after hysterosalpingography with oil soluble contrast medium. Respirology 2004;9:134-136.

  32. Brown W, Moody DM, Challa VR, Stump DA, Hammon JW. Longer duration of cardiopulmonary bypass is associated with greater numbers of cerebral microemboli. Stroke 2000;31:707-713.

  33. Gitin TA, Seidel T, Cera PJ, Glidewell OJ, Smith JL. Pulmonary microvascular fat: the significance? Crit Care Med 1993;21:673-677.

  34. Georgopoulos D, Bouros D. Fat embolism syndrome: clinical examination is still the preferable diagnostic method. Chest 2003;123:982-983.

  35. Arthurs MH, Morgan OS, Sivapragasam S. Fat embolism syndrome following long bone fractures. West Indian Med J 1993;42:115-117.

  36. Lindeque BG, Schoeman HS, Dommisse GF, Boeyens MC, Vlok AL. Fat embolism and the fat embolism syndrome. A double-blind therapeutic study. J Bone Joint Surg Br 1987;69:128-131.

  37. Chan KM, Tham KT, Chiu HS, Chow YN, Leung PC. Post-traumatic fat embolism-its clinical and subclinical presentations. J Trauma 1984;24:45-49.

  38. Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br 1974;56:408-416.

  39. Jacobson DM, Terrence CF, Reinmuth OM. The neurologic manifestations of fat embolism. Neurology 1986;36:847-851.

  40. Babikian VL, Caplan LR. Brain embolism is a dynamic process with variable characteristics. Neurology 2000;54:797-801.

  41. Kim HJ, Lee CH, Lee SH, et al. Early development of vasogenic edema in experimental cerebral fat embolism in cats: correlation with MRI and electron microscopic findings. Invest Radiol 2001;36:460-469.

  42. Jaffe FA. Petechial hemorrhages. A review of pathogenesis. Am J Forensic Med Pathol 1994;15:203-207.

  43. Tachakra SS. Distribution of skin petechiae in fat embolism rash. Lancet 1976;1:284-285.

  44. Van Besouw JP, Hinds CJ. Fat embolism syndrome. Br J Hosp Med 1989;42:304-311.

  45. Riding G, Daly K, Hutchinson S, Rao S, Lovell M, McCollum C. Paradoxical cerebral embolization. An explanation for fat embolism syndrome. J Bone Joint Surg Br 2004;86:95-98.

  46. Pell AC, Hughes D, Keating J, Christie J, Busuttil A, Sutherland GR. Brief report: fulminating fat embolism syndrome caused by paradoxical embolism through a patent foramen ovale. N Engl J Med 1993;329: 926-929.

  47. Sukernik MR, Mets B, Bennett-Guerrero E. Patent foramen ovale and its significance in the perioperative period. Anesth Analg 2001;93:1137-1146.

  48. Forteza AM, Rabinstein A, Koch S, et al. Endovascular closure of a patent foramen ovale in the fat embolism syndrome: changes in the embolic patterns as detected by transcranial Doppler. Arch Neurol 2002;59:455-459.

  49. Byrick RJ, Kay JC, Mazer CD, Wang Z, Mullen JB. Dynamic characteristics of cerebral lipid microemboli: videomicroscopy studies in rats. Anesth Analg 2003;97:1789-1794.

  50. Colonna D, Kilgus D, Brown W, Challa V, Stump D, Moody D. Acute brain fat embolization occurring after total hip arthroplasty in the absence of a patent foramen ovale. Anesthesiology 2002;96:1027-1029.

  51. Rautanen M, Gullichsen E, Gronroos J, et al. Catalytic activity of phospholipase A2 in serum in experimental fat embolism in pigs. Eur J Surg 1997;163:449-456.

  52. Bulger EM, Maier RV. Lipid mediators in the pathophysiology of critical illness. Crit Care Med 2000;28 Suppl 4: N27-N36.

  53. Vedrinne JM, Guillaume C, Gagnieu MC, Gratadour P, Fleuret C, Motin J. Bronchoalveolar lavage in trauma patients for diagnosis of fat embolism syndrome. Chest 1992;102:1323-1327.

  54. Godeau B, Schaeffer A, Bachir D, et al. Bronchoalveolar lavage in adult sickle-cell patients with acute chest syndrome: value for diagnostic assessment of fat embolism. Am J Respir Crit Care Med 1996;153:1691-1696.

  55. Ullman E, Brady WJ, Perron AD, Chan T, Mattu A. Electrocardiographic manifestations of pulmonary embolism. Am J Emerg Med 2001;19:514-519.

  56. Arakawa H, Kurihara Y, Nakajima Y. Pulmonary fat embolism syndrome: CT findings in six patients. J Comput Assist Tomogr 2000;24:24-29.

  57. Malagari K, Economopoulos N, Stoupis C, et al. High-resolution CT findings in mild pulmonary fat embolism. Chest 2003;123:1196-1201.

  58. Satoh H, Kurisu K, Ohtani M, et al. Cerebral fat embolism studied by magnetic resonance imaging, transcranial Doppler sonography, and single photon emission computed tomography: case report. J Trauma 1997; 43:345-348.

  59. Takahashi M, Suzuki R, Osakabe Y, et al. Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations. J Trauma 1999; 46;324-327.

  60. Bonne RC, Maunder R, Slotman G, et al. An early test of survival in patients with the adult respiratory syndrome. The PaO2/FiO2 ratio and its differential response to conventional therapy. Prostaglandin E1 Study Group. Chest 1989;96:849-851.




2020     |     www.medigraphic.com