Embolia gordurosa: a assassina oculta para pacientes com trauma!
Fat embolism: the hidden murder for trauma patients!
Malak Bentaleb; Mohammed Abdulrahman; Marcelo Augusto Fontenelle Ribeiro-Junior
Resumo
Introdução: a síndrome da embolia gordurosa (SEG) representa um distúrbio respiratório agudo que ocorre quando uma resposta inflamatória leva a uma embolização de partículas de gordura e medula na corrente sanguínea. A incidência exata da SEG não está bem estabelecida devido à dificuldade de diagnóstico. Tal síndrome está associada principalmente a traumas isolados de ossos longos e geralmente é diagnosticada erroneamente em outros casos de trauma. O escopo deste estudo foi de realizar uma pesquisa e identificar na literatura atual casos de SEG em pacientes com trauma de natureza não ortopédica com o objetivo de definir a etiologia, a incidência e as principais manifestações clínicas.
Métodos: foi realizada uma pesquisa na literatura utilizando como base de dados o PubMed a fim de identificar os relatos e series de casos de embolias gordurosas em pacientes vítimas de traumas de natureza não ortopédica. A pesquisa final resultou em 23 artigos de pacientes que apresentaram embolia gordurosa/SEG devido a trauma não ortopédico.
Resultados: a apresentação e a etiologia dessas embolias gordurosas são variadas e complexas, diferindo de paciente para paciente. Nesta revisão, destacamos a importância de manter uma suspeita clínica de SEG para pacientes vítimas de trauma que se encontrem sob cuidados intensivos.
Conclusão: para ajudar os cirurgiões de trauma e os clínicos a identificar casos de SEG em pacientes com trauma que não apresentam fratura de ossos longos, foram destacados os principais sinais clínicos de SEG, bem como as possíveis opções de tratamento e prevenção.
Palavras-chave
Abstract
Introduction: fat embolism syndrome (FES) is an acute respiratory disorder that occurs when an inflammatory response causes the embolization of fat and marrow particles into the bloodstream. The exact incidence of FES is not well defined due to the difficulty of diagnosis. FES is mostly associated with isolated long bone trauma, and it is usually misdiagnosed in other trauma cases. The scope of this study was to identify and search the current literature for cases of FES in nonorthopedic trauma patients with the aim of defining the etiology, incidence, and main clinical manifestations.
Methods: we perform a literature search via the PubMed journal to find, summarize, and incorporate reports of fat embolisms in patients presenting with non-orthopedic trauma.
Results: the final literature search yielded 23 papers of patients presenting with fat embolism/FES due to non-orthopedic trauma. The presentation and etiology of these fat embolisms is varied and complex, differing from patient to patient. In this review, we highlight the importance of maintaining a clinical suspicion of FES within the trauma and critical care community.
Conclusion: to help trauma surgeons and clinicians identify FES cases in trauma patients who do not present with long bone fracture, we also present the main clinical signs of FES as well as the possible treatment and prevention options.
Keywords
Referências
1 E Von Bergmann. Ein fall todlicher fettembolie. Berliner Klinische Wochenschrift 1873.
2 Kwiatt ME, Seamon MJ. Fat embolism syndrome. Int J Crit Illn Inj Sci. 2013;3:64-8. doi: 10.4103/2229-5151.109426.
3 Adeyinka A, Pierre L. Fat Embolism. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023 Available from: http://www.ncbi.nlm.nih.gov/books/NBK499885/
4 Kosova E, Bergmark B, Piazza G. Fat embolism syndrome. Circulation. 2015;131:317-20. doi: 10.1161/CIRCULATIONAHA.114.010835.
5 Lempert M, Halvachizadeh S, Ellanti P, Pfeifer R, Hax J, Jensen KO, et al. Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time-A Systematic Review. J Clin Med. 2021;10:2733. doi: 10.3390/jcm10122733.
6 Timon C, Keady C, Murphy CG. Fat Embolism Syndrome - A Qualitative Review of its Incidence, Presentation, Pathogenesis and Management. Malays Orthop J. 2021;15:1-11. doi: 10.5704/MOJ.2103.001.
7 Luff D, Hewson DW. Fat embolism syndrome. BJA Educ. 2021;21:322-8. doi: 10.1016/j.bjae.2021.04.003.
8 Shaikh N, Parchani A, Bhat V, Kattren MA. Fat embolism syndrome: clinical and imaging considerations: case report and review of literature. Indian J Crit Care Med. 2008;12: 32-6. doi: 10.4103/0972-5229.40948.
9 Milroy CM, Parai JL. Fat Embolism, Fat Embolism Syndrome and the Autopsy. Acad Forensic Pathol. 2019;9:136-54. doi: 10.1177/1925362119896351.
10 George J, George R, Dixit R, Gupta RC, Gupta N. Fat embolism syndrome. Lung India. 2013;30:47-53. doi: 10.4103/0970-2113.106133.
11 Georgopoulos D, Bouros D. Fat embolism syndrome: clinical examination is still the preferable diagnostic method. Chest. 2003;123:982-3. doi: 10.1378/chest.123.4.982.
12 Aggarwal R, Banerjee A, Soni KD, Kumar A, Trikha A. Clinical characteristics and management of patients with fat embolism syndrome in level I Apex Trauma Centre. Chin J Traumatol. 2019;22:172-6. doi: 10.1016/j.cjtee.2019.01.007.
13 Aggarwal R, Pal S, Soni KD, Gamangatti S. Massive cerebral fat embolism leading to brain death: A rare presentation. Indian J Crit Care Med. 2015;19:687-9. doi: 10.4103/0972-5229.169358.
14 Kainoh T, Iriyama H, Komori A, Saitoh D, Naito T, Abe T. Risk Factors of Fat Embolism Syndrome After Trauma: A Nested Case-Control Study With the Use of a Nationwide Trauma Registry in Japan. Chest. 2021;159:1064-71. doi: 10.1016/j.chest.2020.09.268.
15 Fulde GW, Harrison P. Fat embolism--a review. Arch Emerg Med. 1991;8:233-9. doi: 10.1136/emj.8.4.233.
16 Nixon MJ, Grant T. Subacute fat embolism syndrome in a young female trauma patient during COVID-19. J Surg Case Rep. 2021;2021(10):rjab485. doi: 10.1093/jscr/rjab485.
17 Stein PD, Yaekoub AY, Matta F, Kleerekoper M. Fat embolism syndrome. Am J Med Sci. 2008;336:472-7. doi: 10.1097/MAJ.0b013e318172f5d2.
18 White T, Petrisor BA, Bhandari M. Prevention of fat embolism syndrome. Injury. 2006;37Suppl 4:S59-67. doi: 10.1016/j.injury.2006.08.041.
19 He Z, Shi Z, Li C, Ni L, Sun Y, Arioli F, Wang Y, Ammirati E, et al. Single-case metanalysis of fat embolism syndrome. Int J Cardiol. 2021;345:111-7. doi: 10.1016/j.ijcard.2021.10.151.
20 Li S, Zou D, Qin Z, Liu N, Zhang J, Li Z, et al. Nonfracture-associated pulmonary fat embolism after blunt force fatality: case report and review of the literature. Am J Forensic Med Pathol. 2015;36:61-5. doi: 10.1097/PAF.0000000000000142.
21 Nichols GR, Corey TS, Davis GJ. Nonfracture-associated fatal fat embolism in a case of child abuse. J Forensic Sci. 1990;35:493-9.
22 Xu L, Tan X, Chen X, Du S, Yue X, Qiao D. Rare, fatal pulmonary fat embolism after acupuncture therapy: A case report and literature review. Forensic Sci Int. 2023;345:111619. doi: 10.1016/j.forsciint.2023.111619.
23 Pham MQ. Fat Embolism After Plastic Surgery: A Case Report. Plast Aesthetic Nurs. 2022;42:27-30. doi: 10.1097/PSN.0000000000000414.
24 Wolfe EM, Weber LE, Wo LM, Samaha MJ, Mathew P, Garcia O, et al. Two Cases Surviving Macro Fat Emboli Complications Following Gluteal Fat Grafting. Aesthet Surg J. 2022;42:902-6. doi: 10.1093/asj/sjac063.
25 Kadar A, Shah VS, Mendoza DP, Lai PS, Aghajan Y, Piazza G, et al. Case 39-2021: A 26-Year-Old Woman with Respiratory Failure and Altered Mental Status. N Engl J Med. 2021;385:2464-74. doi: 10.1056/NEJMcpc2107355.
26 Dong W, Wan D-Y, Yang X, Fu M, Liu X, Li H, et al. Delayed onset of fat embolus in the cerebral venous system after breast and hip augmentation: a case report. BMC Neurol. 2021;21:411. doi: 10.1186/s12883-021-02419-x.
27 Dhooghe NS, Maes S, Depypere B, Claes KEY, Coopman R, Kubat B, et al. Fat Embolism After Autologous Facial Fat Grafting. Aesthet Surg J. 2022;42:231-8. doi: 10.1093/asj/sjab252.
28 Uz I, Yalçinli S, Efe M. Fat embolism syndrome after gluteal augmentation with hyaluronic acid: A case report. Ulus Travma Acil Cerrahi Derg. 2020;26(6):960-2. doi:10.14744/tjtes.2019.08433.
29 Wang C, Wang X, Huang J, Yu N, Long X. Severe fat embolism after autologous fat grafting in vaginal tightening and breast augmentation surgery. J Int Med Res. 2020;48:300060520949109. doi: 10.1177/0300060520949109.
30 Meng Y, Zhang M, Ling H, Huang S, Miao Q, Yu Y, et al. Nontraumatic Multiple-Organ Fat Embolism: An Autopsy Case and Review of Literature. Am J Forensic Med Pathol. 2020;41:131-4. doi: 10.1097/PAF.0000000000000544.
31 Lee HS, Park J-J, Roh HG, Lim SD. Unusual clinicopathological presentation of nontraumatic cerebral fat embolism: Two-case report. Medicine (Baltimore). 2020;99:e19574. doi: 10.1097/MD.0000000000019574.
32 Lu Y-Q. Young Woman With Seizures. Ann Emerg Med. 2019;74:305-9. doi: 10.1016/j.annemergmed.2019.02.016.
33 Peña W, Cárdenas-Camarena L, Bayter-Marin JE, McCormick M, Durán H, Ramos-Gallardo G, et al. Macro Fat Embolism After Gluteal Augmentation With Fat: First Survival Case Report. Aesthet Surg J. 2019;39:NP380-NP383. doi: 10.1093/asj/sjz151.
34 Rosenfeld DM, Smith ML, Seamans DP, Giorgakis E, Gaitan BD, Khurmi N, et al. Fatal diffuse pulmonary fat microemboli following reperfusion in liver transplantation with the use of marginal steatotic allografts. Am J Transplant. 2019;19:2640-5. doi: 10.1111/ajt.15399.
35 Zhibin Z, Peng S, Fang C. Fat embolism following a liposuction procedure. Neurol India. 2018;66:1206-7. doi: 10.4103/0028-3886.236965.
36 Scarpino M, Lanzo G, Moretti M, Olivo G, Amantini A, Grippo A. Delayed cerebral fat embolism occurring after off-pump coronary artery bypass grafting. Cardiol J. 2018;25: 155-7. doi: 10.5603/CJ.2018.0015.
37 Ali A, Theobald G, Arshad MA. Fat attacks! a case of fat embolisation syndrome postliposuction. BMJ Case Rep. 2017;2017:bcr2017220789. doi: 10.1136/bcr-2017-220789.
38 Cantu CA, Pavlisko EN. Liposuction-induced fat embolism syndrome. BMJ Case Rep. 2017;2017:bcr2017219835. doi: 10.1136/bcr-2017-219835.
39 Sato HK, Kowacs PA, Dalmau J, Santos PSF. Fat embolism showing restriction on diffusion sequence in brain magnetic resonance imaging. Arq Neuropsiquiatr. 2016;74:597-8. doi: 10.1590/0004-282X20160052.
40 Mendoza-Morales RC, Camberos-Nava EV, Luna-Rosas A, Garcés-Ramírez L, De la Cruz F, García-Dolores F. A fatal case of systemic fat embolism resulting from gluteal injections of vitamin e for cosmetic enhancement. Forensic Sci Int. 2016;259:e1-4. doi: 10.1016/j.forsciint.2015.11.012.
41 Jacob S, Courtwright A, El-Chemaly S, Racila E, Divo M, Burkett P, et al. Donor-acquired fat embolism syndrome after lung transplantation. Eur J Cardio-Thorac Surg. 2016;49:1344-7. doi: 10.1093/ejcts/ezv347.
42 Berger N, Paula P, Gascho D, Flach PM, Thali MJ, Ross SG, et al. Bone marrow edema induced by a bullet after a self-inflicted accidental firing. Leg Med (Tokyo). 2013;15:329-31. doi: 10.1016/j.legalmed.2013.09.002.
43 Bajraktari M, Naco M, Huti G, Arapi B, Domi R. Fat Embolism Syndrome Without Bone Fracture: Is It Possible? Open Access Maced J Med Sci. 2022;10:331-5. doi: 10.3889/oamjms.2022.11169.
44 Fowler JB, Fiani B, Sarhadi K, Cortez V. Cerebral fat embolism in the absence of a long bone fracture: A rare case report. Surg Neurol Int. 2021;12:78. doi: 10.25259/SNI_946_2020.
45 Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, et al. Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. Ann Intern Med. 1983;99:438-43. doi: 10.7326/0003-4819-99-4-438.
46 Newbigin K, Souza CA, Torres C, Marchiori E, Gupta A, Inacio J, et al. Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings. Respir Med. 2016;113:93-100. doi: 10.1016/j.rmed.2016.01.018.
47 Mellor A, Soni N. Fat embolism. Anaesthesia. 2001;56:145-54. doi: 10.1046/j.1365-2044.2001.01724.x.
48 Gupta A, Reilly CS. Fat embolism. Contin Educ Anaesth Crit Care Pain. 2007;7:148-51. doi: 10.1093/bjaceaccp/mkm027.
49 Bardana D, Rudan J, Cervenko F, Smith R. Fat embolism syndrome in a patient demonstrating only neurologic symptoms. Can J Surg. 1998;41:398-402.
50 Shaikh N. Emergency management of fat embolism syndrome. J Emerg Trauma Shock. 2009;2:29-33. doi: 10.4103/0974-2700.44680.
51 Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome. A 10-year review. Arch Surg. 1997;132(4):435-9. doi: 10.1001/archsurg.1997.01430280109019.
52 Fabian TC, Hoots AV, Stanford DS, Patterson CR, Mangiante EC. Fat embolism syndrome: prospective evaluation in 92 fracture patients. Crit Care Med. 1990;18:42-6.
53 Kao Y-M, Chen K-T, Lee K-C, Hsu C-C, Chien Y-C. Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases. Healthc Basel Switz. 2023;11:1391. doi: 10.3390/healthcare11101391.
54 Van den Brande FGJ, Hellemans S, De Schepper A, De Paep R, Op De Beeck B, De Raeve HR, Jorens PG. Post-traumatic severe fat embolism syndrome with uncommon CT findings. Anaesth Intensive Care. 2006;34:102-6. doi: 10.1177/0310057X0603400120.
55 Godoy DA, Di Napoli M, Rabinstein AA. Cerebral Fat Embolism: Recognition, Complications, and Prognosis. Neurocrit Care. 2018;29:358-65. doi: 10.1007/s12028-017-0463-y.
56 Giyab O, Balogh B, Bogner P, Gergely O, Tóth A. Microbleeds show a characteristic distribution in cerebral fat embolism. Insights Imaging. 2021;12:42. doi: 10.1186/s13244-021-00988-6.
57 Vedrinne JM, Guillaume C, Gagnieu MC, Gratadour P, Fleuret C, Motin J. Bronchoalveolar lavage in trauma patients for diagnosis of fat embolism syndrome. Chest. 1992;102:1323-7. doi: 10.1378/chest.102.5.1323.
58 Rothberg DL, Makarewich CA. Fat Embolism and Fat Embolism Syndrome. J Am Acad Orthop Surg. 2019;27:e346-e355. doi: 10.5435/JAAOS-D-17-00571.
59 Kawakami D, Yoshino S, Kawakami S, Yamakawa R. Fat embolism syndrome. Intensive Care Med. 2022;48:748-9. doi: 10.1007/s00134-022-06664-7.
60 Alfudhili K. Pearls in Pulmonary Computed Tomography Findings in Patients With Fat Embolism Syndrome. Can Assoc Radiol J. 2018;69(4):479-88. doi: 10.1016/j.carj.2018.07.002.
61 Bederman SS, Bhandari M, McKee MD, Schemitsch EH. Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis. Can J Surg. 2009;52(5):386-93.
62 Piastra M, Picconi E, Morena TC, Ferrari V, Gelormini C, Caricato A, et al. Multisystemic involvement of post-traumatic fat embolism at a Pediatric Trauma Center: a clinical series and literature review. Eur J Pediatr. 2023;182:1811-21. doi: 10.1007/s00431-023-04869-6.
63 Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336-40.
64 Richards RR. Fat embolism syndrome. Can J Surg. 1997;40: 334-9.
65 Ding YJ, Zhang L, Sun XW, Lin YN, Li QY. Rapid recovery of fat embolism syndrome with acute respiratory failure due to liposuction. Respirol Case Rep. 2022;10:e01047. doi: 10.1002/rcr2.1047.
66 Momii K, Shono Y, Osaki K, Nakanishi Y, Iyonaga T, Nishihara M, et al. Use of venovenous extracorporeal membrane oxygenation for perioperative management of acute respiratory distress syndrome caused by fat embolism syndrome: A case report and literature review. Medicine (Baltimore). 2021;100:e24929. doi: 10.1097/MD.0000000000024929.
67 Lari A, Abdulshakoor A, Zogheib E, Assaf N, Mojallal A, Lari A-R, et al. How to Save a Life From Macroscopic Fat Embolism: A Narrative Review of Treatment Options. Aesthet Surg J. 2020;40:1098-107. doi: 10.1093/asj/sjz277.
Submetido em:
16/11/2023
Aceito em:
08/03/2024
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