What initial management strategies should be implemented for a patient suspected of having fat embolism syndrome?

Initial management of a patient suspected of fat embolism syndrome (FES) focuses on supportive care aimed at stabilising respiratory and haemodynamic status. This includes immediate oxygen supplementation to maintain adequate oxygenation and prevent hypoxia, which is critical given the risk of acute respiratory distress syndrome (ARDS) in FES ¹.

Early immobilisation and stabilization of long bone fractures are essential to reduce further fat emboli release into the circulation, as recommended in fracture management guidelines ¹.

Monitoring in an intensive care setting is advised for patients with respiratory compromise or neurological symptoms, with readiness to provide mechanical ventilation if respiratory failure develops ¹.

Fluid management should be cautious to avoid fluid overload, which can exacerbate pulmonary oedema, while ensuring adequate organ perfusion ¹.

In severe cases with refractory hypoxaemia or ARDS, advanced supportive therapies such as venovenous extracorporeal membrane oxygenation (ECMO) may be considered, as recent case reports and reviews have demonstrated successful perioperative use of ECMO in FES-induced ARDS (Momii et al., 2021).

There is no specific pharmacological treatment for FES; thus, management remains largely supportive with close monitoring for neurological deterioration and multi-organ involvement (Scarpino et al., 2019).