What is the treatment for fat embolism syndrome (FES)?

From the Guidelines

Fat embolism syndrome treatment should prioritize early definitive osteosynthesis of long-bone fractures to prevent ARDS and fat embolism syndrome, as recommended in the most recent guidelines 1.

Key Considerations

• The primary goal is to prevent further complications such as ARDS and fat embolism syndrome by stabilizing the fracture early on.
• In patients who are haemodynamically unstable or have severe preoperative respiratory compromise, a multidisciplinary discussion is necessary to weigh the benefits and risks of definitive osteosynthesis versus external fixation 1.
• Supportive care, including respiratory support with supplemental oxygen and fluid resuscitation, is crucial in managing fat embolism syndrome.
• The use of corticosteroids, such as methylprednisolone, is controversial and should be approached with caution due to potential detrimental effects in certain patient populations 1.

Management Strategies

• Early immobilization of fractures to prevent additional fat from entering the circulation.
• Continuous monitoring of vital signs, arterial blood gases, and neurological status.
• Pain management with appropriate analgesics.
• Prophylactic anticoagulation with low molecular weight heparin to prevent deep vein thrombosis.

Decision Making

• The decision to perform definitive osteosynthesis or external fixation should be made on a case-by-case basis, considering the patient's overall condition and the potential risks and benefits of each approach 1.
• The most recent guidelines should be consulted to ensure that treatment is aligned with current best practices 1.

From the Research

Fat Embolism Syndrome Treatment

• The treatment of fat embolism syndrome (FES) primarily focuses on supportive care, including oxygen therapy, fluid management, and hemodynamic stabilization 2, 3.
• In severe cases, advanced life support such as extracorporeal membrane oxygenation (ECMO) may be required to manage refractory hypoxemia and hemodynamic instability 4.
• Early supportive pulmonary therapy and other resuscitative measures may halt the pathophysiologic cascade and prevent clinical deterioration 2.
• Medical care is prophylactic or supportive, including early fixation and general ICU management to ensure adequate oxygenation and ventilation, hemodynamic stability, prophylaxis of deep venous thrombosis, stress-related gastrointestinal bleeding, and nutrition 5.
• The main therapeutic interventions once FES has been clinically diagnosed are directed towards support of pulmonary and neurological manifestations and management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) 5.
• Corticosteroids may be used in the treatment of FES, although their role remains controversial 3, 6.
• Early stabilization of long bone fractures has been shown to decrease the incidence of pulmonary complications 3.

Specific Treatment Approaches

• ECMO has been shown to be a crucial bridge to recovery for patients with FES who do not respond to conventional therapies 4.
• High-dose corticosteroid and sivelestat sodium may be effective in treating FES, as seen in a case report of a 78-year-old woman with acute chronic respiratory failure due to FES 6.
• Mechanical ventilation may be indicated in cases of respiratory failure due to FES 6.