経皮的人工心肺補助により救命し得た電撃型脂肪塞栓症候群の１例

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  • A case of fulminant fat embolism syndrome rescued by percutaneous cardiopulmonary support

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We experienced a case of severe fat embolism syndrome (FES) who was successfully treated by percutaneous cardiopulmonary support (PCPS). An 18-year-old man sustained a fracture of femoral shaft but no chest and head injury after a traffic accident. Upon admission his respiratory condition was normal, but 12 hours later respiratory failure suddenly developed. Seventeen hours after the admission, he was admitted to our ICU for the treatment of acute respiratory failure due to FES. He was immediately intubated and mechanically ventilated. The chest X-ray film on ICU admission demonstrated “snow storm shadow”. However, his pulmonary oxygenation and haemodynamics were not improved at all, then we selected PCPS for his critical situation. After the introduction of PCPS, his oxygenation and haemodynamics were gradually improved, and he was free from PCPS on day 2. In addition, we administered high doses of methylprednisolone (1g·day-1) for 3 days and sivelestat for 14 days. We observed many high echoic matters streaming through the inferior vena cava for 5 days in ultrasound cardiography. He was weaned from mechanical ventilation on day 10. Magnetic resonance imaging was performed on day 14, which showed high intensity area in corpus callosum. On day 40 he was performed the internal fixation of his fracture, and was finally discharged from the hospital without any neurological deficit on day 129, when high intensity area shown in MRI on day 14 had already disappeared. This case suggested that urgent and transient use of PCPS is a useful tool to rescue for fulminant FES.

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