'Low-dose' corticosteroid prophylaxis against fat embolism.
The effect of 'low-dose' corticosteroids (9 mg/kg methylprednisolone), given after skeletal trauma, on the incidence of the fat embolism syndrome and isolated arterial hypoxemia was studied in 42 controls and 40 steroid-treated subjects. Fat embolism occurred in ten controls (23.8%) and one steroid-treated subject (2.5%) (p = 0.01). A further 44 subjects developed isolated hypoxemia. This was severe (PaO2 less than 50 mm Hg) in seven of 32 controls (21.9%) and one of 39 steroid-treated subjects (2.6%) (p = 0.01). The overall incidence of hypoxemia was 67.1%, affecting 33 controls (78.6%) and 22 steroid-treated patients (55%) (p less than 0.05). The degree of hypoxemia was severe (PaO2 less than 50 mm Hg) in 12 controls (28.6%) and two (5%) of the steroid-treated subjects (p = 0.005). No control subject died or required mechanical ventilation. One steroid-treated subject without fat embolism died of a fulminant infection. Although methylprednisolone in a relatively low dose provides protection against fat embolism and pulmonary dysfunction after skeletal trauma, the safety of this therapy requires further evaluation.
Kallenbach
J
J
Department of Respiratory Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Lewis
M
M
Zaltzman
M
M
Feldman
C
C
Orford
A
A
Zwi
S
S
D000328:Adult; D002986:Clinical Trials as Topic; D004620:Embolism, Fat / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005264:Femoral Fractures / Q000150:complications*; D005360:Fibula / Q000293:injuries*; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D013978:Tibial Fractures / Q000150:complications*
D008775:Methylprednisolone