FAT-EMBOLISM SYNDROME (FES) IN TRAUMATIZED PATIENTS - A 5-YEAR EXPERIENCE OF A SINGLE INTENSIVE-CARE UNIT (ICU)

During the period 1988-1993, twenty tree (23) patients (18 males and 5 females with a mean age 37.2 years), who had sustained multiple injur ies and were reported to have Fat Embolism Syndrome (FAT), were treate d in our Intensive Care Unit (ICU). Here, we describe, retrospectively , our experience with these cases. In all patients the diagnosis was d ocumented by Guard's criteria: a) Major: petechial rash 7 (30.4%), res piratory symptoms 23 (100%), cerebral signs 5 (21.7%), b) Minor: tachy cardia 23 (100%), pyrexia 18 (78.2%), retinal changes 7 (30.4%) and c) Laboratory: low haematocrit 23 (100%), fat in sputum 16 (69.5%), fat macroglobulinaemia 14 (60.8%). All patients needed volume replacement, they were given high doses of steroids and received supplemental oxyg en by Venturi/Mask. 8 patients (34.7%) developed full Adult Respirator y Distress Syndrome (ARDS) and were put on Mechanical Ventilation and 2 of them died. The mean duration of stay in the ICU was 15 +/- 12 day s and the mean duration of Mechanical Ventilation was 18 +/- 10 days. We support the diagnostic value of Guard's criteria, the beneficial ef fects of adequate circulating volume and the steroid therapy as well a s the reduction of the severity of FES when oxygen is administrated as soon as possible and avoidance of hypoxaemia is obtained.