title: Inhalational Ciclesonide found beneficial in prevention of fat embolism syndrome and improvement of hypoxia in isolated skeletal trauma victims.
abstract: BACKGROUND
  Many studies have established intravenous corticosteroid as an effective prophylactic therapy in fat embolism syndrome (FES). However, its use is limited among surgeons because of systemic side effects. Inhalational steroids have least systemic effects and are widely used for several chest conditions (i.e., asthma), but their effectiveness in FES has not been established.
  
  
  OBJECTIVE
  This study was sought to evaluate the (1) efficacy and (2) safety of inhalational Ciclesonide (CIC) in prevention of FES and treatment of hypoxemia in isolated skeletal trauma victims.
  
  
  METHODS
  A nonrandomized prospective control trial was designed in which all patients between 18 and 40 years with isolated skeletal injury who presented within 8 h of injury were allocated to either Trial group or control group. Trial group patients received 640 mcg of inhalational CIC with a metered-dose inhaler at the time of admission, and at 24 h. Control group patients did not receive any prophylactic therapy. Both groups were evaluated for development of FES (Gurd's criteria) and hypoxemia (PaO2<70 mmHg) for 72 h. The complications related to CIC administration were evaluated in trial group patients during their hospital stay.
  
  
  RESULTS
  Of 35 patients in each group, two patients in Trial group and nine patients in control group developed FES (P = 0.022). Eight patients in Trial group had hypoxemia at the time of admission, six of them improved and one additional patient developed hypoxemia after inhalational CIC administration. In control group, ten patients had hypoxia at the time of admission, only one of them improved and remaining nine patients had persistent hypoxemia even after 72 h. Additionally, three patients developed hypoxemia. A significant improvement in hypoxemia and a significant decrease in the incidence of FES were observed in Trial group (P < 0.05) compared to control group. None of the patients presented with any complications or adverse effects of steroid in Trial group.
  
  
  CONCLUSIONS
  Inhalational CIC is a safe and effective therapy for prevention of FES and also an effective drug for treatment of hypoxemia in orthopedic trauma victims.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Sen
authors.affiliation: Department of Orthopaedics, Ex-resident Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Prakash
authors.affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India. sujitortho@yahoo.co.in.|Department of Orthopaedics, AIIMS, Bhubaneswar, 751019, India. sujitortho@yahoo.co.in.
authors.forename: S K
authors.initials: SK
authors.lastname: Tripathy
authors.affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
authors.forename: A
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Anesthesia and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: I M
authors.initials: IM
authors.lastname: Sen
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D004620:Embolism, Fat / Q000150:complications* / Q000517:prevention & control*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000517:prevention & control*; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000150:complications*; D011282:Pregnenediones / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D011282:Pregnenediones; C120481:ciclesonide
keywords: Ciclesonide; Corticosteroid; Fat embolism syndrome; Gurd`s criteria; Inhalational steroid