Clinical presentation and prognostic factors in fat embolism syndrome

Fat embolism occurs in most of the patients following long bone fractures but 1–5% of these present clinically as fat embolism syndrome. The recorded data of 64 patients having uncomplicated long bone fractures without head and chest injuries admitted to our ICU with diagnosis of FES over a period of 3 years was evaluated to determine factors effecting management and prognosis. Forty-two patients belonged to subacute and 29 to fulminant FES group depending upon their clinical status at the time of ICU admission.

Majority of FES patient had fracture femur and presented with respiratory distress as initial symptom. Lung injury score was 1.34 ± 0.64 in subacute and 3.36 ± 0.44 in fulminant group (P < 0.01). Patients with fulminant FES had more number of abnormal laboratory parameters. Eighteen patients (43%) in subacute and all patients in fulminant group required ventilation. There was significant delay from FES presentation to ICU admission for subacute FES patients requiring ventilatory support than the patients improving with conservative therapy alone (P < 0.05) One patient in subacute (2.3%) and 10 patients in fulminant FES group (45.5%) died. The compliance of respiratory system (C_rs) the start of intermittent positive pressure ventilation was significantly less in fulminant as compared to subacute FES patients (P < 0.05). Most of the ventilated patients had initial improvement in C_rs with ventilation but only those patients who made continuous improvement in C_rs beyond 48 h of ventilation ultimately maintained oxygenation and survived in both the groups. We conclude that early ICU admission and supportive therapy is important determinant of morbidity in FES. Patients with more number of abnormal laboratory parameters and those in whom C_rs and oygenation index does not improve even after 48 h of adequate ventilatory support are unlikely to improve by conventional ventilatory support alone and need to be shifted to other modalities maintaining oxygenation.