Based on experience gained in the management of thirteen consecutive cases of fat-embolism syndrome with 100 per cent survival, a treatment program was developed on the assumption that the potentially fatal feature is hypoxia secondary to pulmonary insufficiency. Blood-gas studies were done immediately on all patients who exhibited any combination of tachycardia, tachypnea, pyrexia, and impairment of consciousness after trauma. An arterial oxygen level below fifty millimeters of mercury was an indication for vigorous treatment. Therapy in severe cases included controlled, positive pressure ventilation with positive end-expiratory pressure and diuretics as indicated. The goal of treatment was to maintain arterial oxygen above fifty millimeters of mercury until the pathological process in the lungs resolved and normal function was restored. All patients survived.
From the Departments of Orthopedic Surgery and Anesthesia, Upstate Medical Center, State University of New York, Syracuse