Trauma case reports · 2025
Fat embolism syndrome following severe blunt chest trauma treated with veno-venous extracorporeal membrane oxygenation: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Kasahara Shun, Maruhashi Takaaki, Akinaga Seishiro, Takahashi Ayumi, Okazaki Kanako, Oi Marina, Kurihara Yutaro, Asari Yasushi
Аннотация
BACKGROUND: Fat embolism syndrome (FES) often occurs following long bone fractures and presents with respiratory symptoms in 90 % of cases. Although rare, the mortality rate ranges from 5 % to 20 %. Its pathophysiology involves fat obstruction in the pulmonary arteries or free fatty acids that damage the alveoli. Treatment primarily involves supportive care, including lung-protective ventilation strategies such as acute respiratory distress syndrome (ARDS) management. We report a case of severe FES that required veno-venous extracorporeal membrane oxygenation (VV-ECMO).
CASE PRESENTATION: A man in his 30s sustained multiple traumatic injuries, including bilateral pneumothorax, unstable pelvic fractures, and multiple rib and limb fractures, after falling from the seventh floor of a building. The Injury Severity Score and probability of survival were 43 and 10.4 %, respectively. The initial management included chest drainage, external pelvic fixation, and massive transfusion. On day 9, the patient developed ARDS (PaO2/FiO2 ratio, 100) with features that met the Gurd's criteria for FES. Conventional ARDS therapies were limited owing to existing air leaks and mechanical constraints from pelvic fixation. VV-ECMO was initiated on day 10 alongside lung-rest ventilation and hydrocortisone therapy. The patient's respiratory status improved, allowing ECMO weaning by day 28. The patient was discharged from the intensive care unit on day 62.
CONCLUSION: VV-ECMO can be life-saving for FES with ARDS, especially when standard treatments are not feasible owing to injury constraints. Early implementation is recommended in select cases to improve outcomes.
CASE PRESENTATION: A man in his 30s sustained multiple traumatic injuries, including bilateral pneumothorax, unstable pelvic fractures, and multiple rib and limb fractures, after falling from the seventh floor of a building. The Injury Severity Score and probability of survival were 43 and 10.4 %, respectively. The initial management included chest drainage, external pelvic fixation, and massive transfusion. On day 9, the patient developed ARDS (PaO2/FiO2 ratio, 100) with features that met the Gurd's criteria for FES. Conventional ARDS therapies were limited owing to existing air leaks and mechanical constraints from pelvic fixation. VV-ECMO was initiated on day 10 alongside lung-rest ventilation and hydrocortisone therapy. The patient's respiratory status improved, allowing ECMO weaning by day 28. The patient was discharged from the intensive care unit on day 62.
CONCLUSION: VV-ECMO can be life-saving for FES with ARDS, especially when standard treatments are not feasible owing to injury constraints. Early implementation is recommended in select cases to improve outcomes.