Use of early inhaled nitric oxide therapy in fat embolism syndrome to prevent right heart failure.
Evgeni BrotfainLeonid KoyfmanRuslan KutzAmit FrenkelShaun E GruenbaumAlexander ZlotnikMoti KleinPublished in: Case reports in critical care (2014)
Fat embolism syndrome (FES) is a life-threatening condition in which multiorgan dysfunction manifests 48-72 hours after long bone or pelvis fractures. Right ventricular (RV) failure, especially in the setting of pulmonary hypertension, is a frequent feature of FES. We report our experience treating 2 young, previously healthy trauma patients who developed severe hypoxemia in the setting of FES. Neither patient had evidence of RV dysfunction on echocardiogram. The patients were treated with inhaled nitric oxide (NO), and their oxygenation significantly improved over the subsequent few days. Neither patient developed any cardiovascular compromise. Patients with FES that have severe hypoxemia and evidence of adult respiratory distress syndrome (ARDS) are likely at risk for developing RV failure. We recommend that these patients with FES and severe refractory hypoxemia should be treated with inhaled NO therapy prior to the onset of RV dysfunction.
Keyphrases
- mycobacterium tuberculosis
- nitric oxide
- case report
- heart failure
- pulmonary hypertension
- cystic fibrosis
- newly diagnosed
- early onset
- oxidative stress
- end stage renal disease
- adipose tissue
- chronic kidney disease
- ejection fraction
- nitric oxide synthase
- machine learning
- hydrogen peroxide
- prognostic factors
- acute respiratory distress syndrome
- fatty acid
- peritoneal dialysis
- left ventricular
- young adults
- body composition
- mechanical ventilation
- soft tissue
- cardiac resynchronization therapy