Successful management of respiratory distress in fat embolism syndrome: A case report and literature review

Introduction and importance: Treatment of respiratory distress in fat embolism syndrome (FES) often ends in death. FES is generally associated with orthopedic trauma, with the highest incidence in long bone fractures. Case presentation: We present a case, 20-year-old woman with an initial diagnosis of a closed fracture in the right femur and left cruris after traffic accidents, underwent open reduction and internal fixation 17 h after an incident. Thirty hours after the surgery, she experienced respiratory distress, loss of consciousness, and petechial rash. Thoracic radiography revealed bilateral patchy infiltrates; brain CT found cerebral oedema; brain MRI showed multiple small non-confluent lesions; arterial blood gas analysis indicated respiratory acidosis; pulse oximetry was 95 %, leading to a diagnosis of FES. Complete blood count revealed anaemia through a decrease in haemoglobin, haematocrit, increase in erythrocyte sedimentation rate, thrombocytopenia, hypocalcaemia, and hypoalbuminemia. The patient was promptly transferred to the intensive care unit with central venous pressure measuring, consulted to a neurologist, pulmonologist, anaesthesiologist, and cardiologist for supportive treatment and mechanical ventilation for nine days. The patient recovered gradually to be normal. FES treatment has been successful, and the patient discharged after 16 days. Clinical discussion: The prevention of FES depends on timing, surgical technique, and early diagnosis. Early surgical fixation of long bone fractures within 24 h reduces pulmonary complications by 70%. FES can present in a wide variety of severity and symptom. There is no specific treatment. Conclusion: Prevention, early diagnosis, and prompt management of FES are the cornerstone in managing this condition.