Effect of intravenous methylprednisolone in prevention of arterial hypoxemia due to fat embolism syndrome in patients with long bone fractures of lower limb – A double blind randomized trial

Abstract

Background: The fat embolism syndrome (FES) denotes clinical or subclinical respiratory insufficiency developing in patients with long-bone fractures. It usually runs a mild course and responds well to measures for respiratory support. The subclinical form is detected by blood gas analysis and is associated with a PaO 2 value of less than 60 mmHg. The present randomized double blind trial was conducted to evaluate the effectiveness of intravenous corticosteroids in comparison with placebo for the prevention of arterial hypoxemia in patients with long bone fractures.   Methodology: We conducted a double blinded randomized control trial among 44 patients, who showed signs and symptoms of sub clinical fat embolism and fulfilled our inclusion and exclusion criteria over 2 years period in a tertiary trauma care center. Forty four patients with long bone fractures were randomized as 20 patients in group A (control group) and 23 patients in group B (study group) respectively. The patients in the experimental group received a single dose of 30 mg/kg intravenous methylprednisolone upon admission to the emergency room. The control group received an equal volume of placebo (normal saline).   Results: The primary endpoints evaluated were the presence of fat embolism syndrome, based on the Lindeque’s criteria. Arterial blood gas (ABG) analysis showed PO 2 of 67 ± 13 mmHg in Group A and 73 ± 8 mmHg in Group B. Mean arterial oxygen was not significantly different between the two groups (P = 0.09), this shows that single dose methylprednisolone (30 mg/kg intravenously) is effective as prophylaxis for prevention of arterial hypoxia in fat embolism syndrome. Among 44 patients studied 7 (33.33%) patients out of 21 in Group A manifested clinical FES. In Group B, 2 (8.7%) out of 23 patients had manifestations of the syndrome   Conclusion: Intravenous methylprednisolone administration to patients admitted with long-bone fractures does not offer significant advantages in the maintenance of PaO 2 and SPO 2 levels when compared to placebo (normal saline), but reduces the frequency of development of fat embolism syndrome.   Key words: Arterial blood gas; long bone fracture; methylprednisolone; fat embolism syndrome   Citation: Prashanth N, Neeta PN. Effect of intravenous methylprednisolone in prevention of arterial hypoxemia due to fat embolism syndrome in patients with long bone fractures of lower limb - A double blind randomized trial. Anaesth Pain & Intensive Care 2016;20(3):290-294   Received: 12 May 2016; Reviewed: 18 May & 10 June 2016; Accepted: 15 September 2016