title: Use of early inhaled nitric oxide therapy in fat embolism syndrome to prevent right heart failure.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, Israel.
authors.forename: Evgeni
authors.identifier: 0000-0002-1353-9852
authors.initials: E
authors.lastname: Brotfain
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Koyfman
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, Israel.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Kutz
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Frenkel
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06511, USA.
authors.forename: Shaun E
authors.initials: SE
authors.lastname: Gruenbaum
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zlotnik
authors.affiliation: Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, 85102 Beer-Sheva, Israel.
authors.forename: Moti
authors.initials: M
authors.lastname: Klein