Therapy
If a fat embolism has been diagnosed in the pulmonary or cerebral vessels, an adequate therapy should be initiated as soon as possible. A symptomatic therapy is the main focus. Possible options include inhibition of blood clotting (anticoagulation) and the use of glucocorticoids.
However, the use of anticoagulants in particular must be critically reviewed, since a fat embolism is not a typical embolus consisting of thrombocytes (blood platelets). Glucocorticoids (such as hydrocortisone or prednisolone) can effectively suppress the prevailing inflammatory processes in the pulmonary vessels. Related topics: Therapy of a pulmonary embolismIn addition to these measures, supportive options are also considered.
Here, the patient can be given oxygen to relieve the shortness of breath or, in the case of complete respiratory failure, mechanical ventilation. In the course of the falling blood pressure in pulmonary embolism, it is advisable to supply the patient with fluid to stabilize the circulation. However, the volume should be administered carefully while controlling the pulmonary arterial blood pressure by means of a right heart catheter.
The administration of catecholamines can also stabilize the unbalanced blood pressure situation. Attention should be paid here to controlling the heart rate, as this can already be elevated in the event of a pulmonary embolism. Attention should also be paid to kidney function. In the event of any loss of function, appropriate measures must be taken. Symptomatic treatment is usually followed by intensive medical monitoring with further symptomatic care.
What are the long-term consequences?
If fat embolism is not treated in time, long-term complications may occur. Since the right heart must permanently pump against this increased resistance in the pulmonary vessels in the event of acute occlusion, right heart failure can occur if symptoms persist for a long time. In addition, after a single incident, renewed fat embolisms can occur.
The occlusion of arterial pulmonary vessels reduces the exchange between air and oxygenated blood. As a result, pulmonary alveoli may collapse and empty spaces may develop (atelectasis), which may persist for a long time.The development of these atelectases is due to the reduced production of surfactant, which reduces the surface tension of the alveoli during exhalation and keeps them open. The closure of small arteries can lead to a pulmonary infarction, which is mainly wedge-shaped.
Pneumonia can then develop from this infarct area.
- Infarct Pneumonia
- Therapy of cardiac insufficiency
The acute onset of a fat embolism can be fatal, even if, as mentioned above, rather rare. The occlusion of the pulmonary vessels can, for example, lead to a worsening of the heart weakness and right heart failure in patients with pre-existing right heart failure.
But especially the less frequent occlusions of a cerebral artery can cause life-threatening complications. The most important of these is stroke with neurological symptoms. In this case, it is important to restore the blood flow in the occluded vessel as quickly as possible.
