Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

Arnab Banerjee; Richa Aggarwal; Kapil Dev Soni; Anjan Tirkha

doi:10.1136/bcr-2019-233452

Prone positioning in a patient with fat embolism syndrome presenting as diffuse alveolar haemorrhage: new perspective

BMJ Case Rep. 2020 Mar 10;13(3):e233452. doi: 10.1136/bcr-2019-233452.

Authors

Arnab Banerjee¹, Richa Aggarwal², Kapil Dev Soni¹, Anjan Tirkha³

Affiliations

¹ Critical and Intensive Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
² Critical and Intensive Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India [email protected].
³ Department of Anesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Diffuse alveolar haemorrhage (DAH) is a rare complication of fat embolism syndrome leading to severe hypoxaemia due to the effusion of blood into the alveoli from the damaged pulmonary microvasculature. The management is usually supportive with patients being nursed in supine position. The use of prone position ventilation in a DAH has rarely been reported before. We report an interesting case of a 26-year-old male patient diagnosed with DAH caused by fat embolism in whom prone position ventilation improved the lung dynamics and oxygenation.

Keywords: adult intensive care; emergency medicine; mechanical ventilation; respiratory system; trauma.

Publication types

Case Reports

MeSH terms

Adult
Diagnosis, Differential
Embolism, Fat / diagnosis
Embolism, Fat / etiology*
Embolism, Fat / therapy
Erythrocyte Transfusion
Femoral Fractures / complications*
Hemorrhage / etiology*
Humans
Intubation, Intratracheal
Male
Prone Position
Respiration, Artificial / methods*
Respiratory Distress Syndrome / diagnosis