Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure

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...

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Main Authors:	Evgeni Brotfain, Leonid Koyfman, Ruslan Kutz, Amit Frenkel, Shaun E. Gruenbaum, Alexander Zlotnik, Moti Klein
Format:	Article
Language:	English
Published:	Hindawi Limited 2014-01-01
Series:	Case Reports in Critical Care
Online Access:	http://dx.doi.org/10.1155/2014/506503

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spelling	doaj-3f119c6f24f040dab6614d9047ebca2a2020-11-25T01:07:45ZengHindawi LimitedCase Reports in Critical Care2090-64202090-64392014-01-01201410.1155/2014/506503506503Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart FailureEvgeni Brotfain0Leonid Koyfman1Ruslan Kutz2Amit Frenkel3Shaun E. Gruenbaum4Alexander Zlotnik5Moti Klein6Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, IsraelDepartment of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, IsraelDepartment of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, IsraelDepartment of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, IsraelDepartment of Anesthesiology, Yale University School of Medicine, New Haven, CT 06511, USADepartment of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, IsraelDepartment of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, IsraelFat 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.http://dx.doi.org/10.1155/2014/506503
collection	DOAJ
language	English
format	Article
sources	DOAJ
author	Evgeni Brotfain Leonid Koyfman Ruslan Kutz Amit Frenkel Shaun E. Gruenbaum Alexander Zlotnik Moti Klein
spellingShingle	Evgeni Brotfain Leonid Koyfman Ruslan Kutz Amit Frenkel Shaun E. Gruenbaum Alexander Zlotnik Moti Klein Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure Case Reports in Critical Care
author_facet	Evgeni Brotfain Leonid Koyfman Ruslan Kutz Amit Frenkel Shaun E. Gruenbaum Alexander Zlotnik Moti Klein
author_sort	Evgeni Brotfain
title	Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure
title_short	Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure
title_full	Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure
title_fullStr	Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure
title_full_unstemmed	Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure
title_sort	use of early inhaled nitric oxide therapy in fat embolism syndrome to prevent right heart failure
publisher	Hindawi Limited
series	Case Reports in Critical Care
issn	2090-6420 2090-6439
publishDate	2014-01-01
description	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.
url	http://dx.doi.org/10.1155/2014/506503
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Use of Early Inhaled Nitric Oxide Therapy in Fat Embolism Syndrome to Prevent Right Heart Failure

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