| ¿Reducen los esteroides el riesgo de síndrome de embolismo graso en pacientes con fracturas de huesos largos? Un metaanálisis |
Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis.
Bederman SS, Bhandari M, McKee MD, Schemitsch EH.
Department of Orthopaedic Surgery, University of California at San Francisco, Calif 94143-0728, USA. s.bederman@utoronto.ca
Can J Surg. 2009 Oct;52(5):386-93.
Abstract
BACKGROUND: Fat embolism syndrome (FES) is a potentially lethal condition most commonly seen in polytrauma patients with multiple long-bone fractures. Treatment has centred around supportive care and early fracture fixation. Several small clinical trials have suggested corticosteroids benefit patients with FES, but this treatment remains controversial. Our objective was to determine the effect of corticosteroids in preventing FES in patients with long-bone fractures. METHODS: We conducted a meta-analysis of published studies of patients with long-bone fractures who were randomly assigned to groups receiving corticosteroids or standard treatment for the prevention of FES (1966-2006). Data were extracted on quality, population, intervention and outcomes. Our primary outcome was the development of FES. We used random-effects models to pool results across studies, assessing for study heterogeneity. RESULTS: Of the 104 studies identified, 7 met our eligibility criteria. Overall, the quality of the trials was poor. Our pooled analysis of 389 patients found that corticosteroids reduced the risk of FES by 78% (95% confidence interval [CI] 43%-92%) and that only 8 patients needed to be treated (95% CI 5-13 patients) to prevent 1 case of FES. Similarly, corticosteroids significantly reduced the risk of hypoxia. We found no differences in the rates of mortality or infection. Rates of avascular necrosis were not reported in any of these studies. CONCLUSION: Evidence suggests that corticosteroids may be beneficial in preventing FES and hypoxia but not mortality in patients with long-bone fractures. The risk of infection is not increased with the use of corticosteroids. However, methodological limitations of these trials necessitate a large confirmatory randomized trial.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769117/pdf/0520386.pdf
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| Tratamiento urgente del síndrome de embolismo graso |
Emergency management of fat embolism syndrome.
Shaikh N.
Hamad Medical Corporation, P.Box 3050, Doha-Qatar.
J Emerg Trauma Shock. 2009 Jan;2(1):29-33. doi: 10.4103/0974-2700.44680.
Abstract
Fat emboli occur in all patients with long-bone fractures, but only few patients develop systemic dysfunction, particularly the triad of skin, brain, and lung dysfunction known as the fat embolism syndrome (FES). Here we review the FES literature under different subheadings.The incidence of FES varies from 1-29%. The etiology may be traumatic or, rarely, nontraumatic. Various factors increase the incidence of FES. Mechanical and biochemical theories have been proposed for the pathophysiology of FES. The clinical manifestations include respiratory and cerebral dysfunction and a petechial rash. Diagnosis of FES is difficult. The other causes for the above-mentioned organ dysfunction have to be excluded. The clinical criteria along with imaging studies help in diagnosis. FES can be detected early by continuous pulse oximetry in high-risk patients. Treatment of FES is essentially supportive. Medications, including steroids, heparin, alcohol, and dextran, have been found to be ineffective.
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