RESUMO
INTRODUCTION: fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations. METHODS: we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma. RESULTS: the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community. CONCLUSION: to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.
Assuntos
Embolia Gordurosa , Ferimentos e Lesões , Embolia Gordurosa/etiologia , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/terapia , Humanos , Ferimentos e Lesões/complicaçõesRESUMO
Gluteal augmentation with fat has become one of the most common cosmetic procedures worldwide. Gluteal augmentation is designed to increase the volume and contour of the gluteal region. Intramuscular lipoinjection has been linked to multiple reports of severe complications, including death due to macro fat embolism (MAFE). The authors present the first reported case of survival and successful recovery after MAFE secondary to gluteal augmentation with fat. A 41-year-old woman, ASA II, was scheduled for augmentation mammaplasty, liposuction, and gluteal augmentation with fat. The patient was operated under general anesthesia with a total intravenous anesthesia technique. A total of 3.5 liters of fat was liposuctioned with no complications. The patient was then positioned in a lateral decubitus position for gluteal augmentation with fat. Right after the last injection, the anesthesiologist noticed a sudden change in capnography followed by hypotension, bradycardia, and hypoxemia. The first reaction in the operating room was to consider that the patient was experiencing a severe episode of fat embolism. She was then resuscitated and transferred to a tertiary facility for intensive care management. To our knowledge, this is the first case report of successful resuscitation in a patient experiencing severe MAFE after gluteal augmentation with fat. We believe that this patient survived the event due to early detection, aggressive management, and proper transfer to an intensive care unit. Level of Evidence: 5.
Assuntos
Contorno Corporal/efeitos adversos , Nádegas/cirurgia , Embolia Gordurosa/terapia , Complicações Intraoperatórias/terapia , Embolia Pulmonar/terapia , Tecido Adiposo/transplante , Adulto , Contorno Corporal/métodos , Capnografia , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Lipectomia/efeitos adversos , Lipectomia/métodos , Monitorização Intraoperatória , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Ressuscitação/métodos , Transplante Autólogo/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Liposuction and gluteal lipoinjection are two of the most frequent surgical procedures in body contouring surgery, and two of the most important complications are microscopic (MIFE) and macroscopic (MAFE) fat embolism. Despite a high index of morbidity and mortality, few reports exist about these complications, and although they have the same causal agent, their etiopathogenesis, clinical evolution, treatment, prognosis, and prevention are totally different. Therefore, the authors performed a comprehensive review of the literature to exhaustively analyze both pathologic conditions and present the differences between them. METHODS: A detailed search was carried out in PubMed of studies on humans from 1946 to March of 2017 in any language and including the keywords microscopic fat embolism and macroscopic fat embolism with either liposuction or gluteal lipoinjection. The articles found were selected according to the search criteria and were analyzed to provide the final data and recommendations. RESULTS: Of the 1245 and 26 articles that were found on complications related to liposuction and gluteal lipoinjection, respectively, only 41 on liposuction and microscopic fat embolism and seven on gluteal lipoinjection and microscopic fat embolism met the specific criteria for inclusion in the analysis. Only two articles on liposuction and two on gluteal lipoinjection referred to macroscopic fat embolism as a complication. CONCLUSION: Although microscopic fat embolism and macroscopic fat embolism are pathologic conditions with high morbidity and mortality rates in association with liposuction and gluteal lipoinjection, few reports about them exist; therefore, the authors made recommendations based on this study for their diagnosis, prevention, and treatment.
Assuntos
Contorno Corporal/efeitos adversos , Nádegas/cirurgia , Embolia Gordurosa/etiologia , Lipectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Contorno Corporal/métodos , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/patologia , Embolia Gordurosa/terapia , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/terapia , PrognósticoRESUMO
Fat embolism syndrome (FES) is a rare syndrome caused by embolization of fat particles into multiple organs including the brain. It typically manifests with petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24-48 h of trauma with long-bone fractures or an orthopedic surgery. The diagnosis of FES is based on clinical and imaging findings, but requires exclusion of alternative diagnoses. Although there is no specific treatment for FES, prompt recognition is important because it can avoid unnecessary interventions and clarify prognosis. Patients with severe FES can become critically ill, but even comatose patients with respiratory failure may recover favorably. Prophylactic measures, such as early stabilization of fractures and certain intraoperative techniques, may help decrease the incidence and severity of FES.
Assuntos
Embolia Gordurosa , Embolia Intracraniana , Adulto , Embolia Gordurosa/complicações , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/etiologia , Embolia Gordurosa/terapia , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Masculino , Adulto JovemRESUMO
A embolia gordurosa é constituída pela presença de glóbulos de gordura dentro da microcirculação periférica e pulmonar, com ou sem quadro clínico. Há uma fase precoce, representada por uma obstrução mecânica, e uma fase tardia, representada por um fenômeno inflamatório, que se inicia aproximadamente 48 a 72 horas após a obstrução mecânica. O diagnóstico clínico da síndrome de embolia gordurosa pode ser auxiliado pelos critérios de Gurd-Wilson e deve ser suspeitado em doentes com traumatismo e fraturas de ossos longos e deterioração neurológica de forma inexplicada. É necessário no mínimo um critério maior (insuficiência respiratória, sinais neurológicos não relacionados ao traumatismo craniano e manifestações dermatológicas) e quatro menores ou dois maiores. Exames complementares são geralmente inespecíficos. A tomografia de crânio pode estar normal. A ressonância magnética de encéfalo pode mostrar áreas puntiformes que costumam desaparecer em 20 dias, sugerindo que a lesão pode ser predominantemente inflamatória, e não necrótico-isquêmica. Um tratamento específico para a síndrome de embolia gordurosa não existe. Ele consiste no suporte cardiopulmonar e neurológico, além de prevenção e diagnóstico precoce, auxiliando nos cuidados com o doente.
Fat embolism is constituted by the presence of fat globules in the peripheral microcirculation and lung with or without symptoms. There is an early stage, represented by a mechanical obstruction, and a late phase, represented by an inflammatory process, which begins approximately 48-72 hours after the mechanical obstruction. The clinical diagnosis of the syndrome of fat embolism can be aided by the criteria of Gurd-Wilson, and must be suspected in patients with trauma and long bone fractures and unexplained neurological deterioration. It is necessary at least one major criteria (respiratory failure, neurological signs unrelated to head trauma and skin lesions) and four small or two larger ones. Additional tests are usually nonspecific. CT scan may be normal. MRI may show punctate areas that usually disappear in 20 days, suggesting that the inflammatory lesion may be predominantly necrotic and non-ischemic. Specific treatment for fat embolism syndrome does not exist. It is the neurological and cardiopulmonary support, and prevention and early diagnosis, assisting in patient care.
Assuntos
Humanos , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/terapia , Lesões Encefálicas TraumáticasRESUMO
Fat embolism syndrome (FES) remains a diagnostic challenge for physicians. It is commonly as associated with fractures of long bones and it is a major source of morbidity and mortality inpatients with multiple injuries. Overall mortality is between 5-15 percent in all studies. These facts motivate us to present the case of a young woman suffering bone fractures in both legs during the earthquake in Chile on February 27, 2010. She presented a FES 72 hours later. It is important to understand this syndrome, as it can be confused with other serious diseases that require different management. We should be able to have a high FES suspicion in the appropriate context, in as much as an early diagnosis, and treatment may improve the prognosis of this severe condition.
El síndrome de embolia grasa (SEG) sigue siendo un reto diagnóstico para los médicos. Se asocia fundamentalmente en fracturas de los huesos largos y es una importante fuente de morbilidad y mortalidad en pacientes politraumatizados. La mortalidad general se encuentra entre el 5 a 15 por ciento en todos los estudios. Esto nos motiva a presentar el caso de una mujer joven que 72 horas después de fracturas sufridas durante el terremoto ocurrido en Chile el 27 de febrero del 2010, presentó un SEG. Es importante conocer este síndrome, ya que se puede confundir con otras patologías graves que requieren un manejo distinto y al tener una alta sospecha en el contexto adecuado, se permite un diagnóstico oportuno, tratamiento precoz y mejorar el pronóstico.
Assuntos
Humanos , Adulto , Feminino , Dispneia/etiologia , Embolia Gordurosa/etiologia , Embolia Gordurosa , Fraturas Ósseas/complicações , Diagnóstico Diferencial , Embolia Gordurosa/terapia , Hidrocortisona/uso terapêutico , Desastres Naturais , Oxigenoterapia , Embolia Pulmonar , Fíbula/lesões , Radiografia Torácica , Tomografia Computadorizada por Raios X , Tíbia/lesõesRESUMO
Paciente de 14 años con cuadro de disnea progresiva y tos seca de un dia de evolución. 48 horas antes del ingreso presentó fractura diafisiaria de fémur, por caída de dos metros de altura. El examen físico de ingreso evidenció taquipnea y cianosis leve, como únicas alteraciones de importancia. Teniendo en cuenta los hallazgos en los estudios de imágenes, el cuadro clínico y el antecedente traumático se realizó una impresión diagnostica de embolismo pulmonar graso, lo que se confirmó por la presencia de glóbulos de grasa en el parcial de orina. El paciente evolucionó satisfactoriamente con medidas de soporte.
Assuntos
Embolia Gordurosa/diagnóstico , Embolia Gordurosa , Embolia Gordurosa/terapia , Embolia PulmonarRESUMO
Embolia gordurosa é uma síndrome associada com trauma ortopédico e considerada um subtipo da síndrome de angústia respiratória aguda. O prognóstico depende, sobretudo, da perspicácia do médico em suspeitar precocemente do embolismo e iniciar as medidas preventivas o mais cedo possível...
Assuntos
Humanos , Embolia Gordurosa/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/fisiopatologia , Embolia Gordurosa/prevenção & controle , Embolia Gordurosa/terapia , Ferimentos e Lesões/complicaçõesRESUMO
El síndrome de embolismo graso se presenta como complicación de fracturas en huesos largos y pelvis y, en ocasiones, posterior a procedimientos diagnósticos usados en la práctica médica. El cuadro clínico se caracteriza por insuficiencia respiratoria aguda, deterioro progresivo de sensorio, no explicable por lesiones craneoencefálicas; y rash petequial en piel y mucosas. El diagnóstico se fundamenta en los hallazgos al examen clínico y en estudios paraclínicos poco específicos. La prevención descansa en la fijación quirúrgica precoz de la fractura de los huesos largos comprometidos y el tratamiento consiste en el soporte ventilatorio y circulatorio, así como en el uso profiláctico de esteroides en individuos de alto riesgo
Assuntos
Humanos , Ossos da Extremidade Superior/lesões , Embolia Gordurosa/diagnóstico , Embolia Gordurosa/terapia , Fixação Interna de Fraturas/tendências , Ossos da Perna/lesões , Pelve/lesões , Insuficiência Respiratória/patologiaRESUMO
During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided.