Fat embolism syndrome: A clinical appraisal

Over a four-year period (1987-1990), 28 cases of fat embolism syndome (FES) were prospectively evaluated for clinical, hematological and biochemical manifestations and prognostication. In a total of 2,112 patients admitted to the Intensive Care Unit (ICU), 1.3% were diagnosed as having FES which was also seen in 2.6% of the patients with polytrauma. FES followed multiple fractures in 60.7% of cases; 17.9% of patients had an isolated fracture of the femur. Other predisposing fractures included closed head injury (7.1%), lipectomy (7.1%), and soft tissue injury (3.6%). The mean free interval was 48 +/- 13.1 hours and 64.3% of the patients had the full clinical syndrome. Respiratory insufficiency was the most common abnormality noted. Petechiae were seen in 82% of patients but were observed mostly in the infraclavicular and axillary areas. Other principal manifestations noted included fever (67.8%), anemia (64.3%), jaundice (57.1%), thrombocytopenia (46.4%), and encephalopathy (42.8%). A total of 60.7% of the patients had radiological evidence of ARDS. Cranial computed tomographic (CT) scans in 17.9% cases showed minimal global edema. All patients had supportive management including mechanical ventilition in 78.6% and none of the patients received steroids. During the four-year period, only one patient died (3.6%). We recommend that early and aggressive critical care management can minimize mortality in patients with FES.