Postoperatif Gelişen Yağ Embolisi Sendromunda Yoğun Bakım Yönetimi
Özet
Yağ emboli sendromu (YES), yaralanma sonrası dolaşıma geçen yağ globüllerinin kapiller yatağı bozup mikrosirkülasyonu etkileyerek sistemik inflamatuar yanıt sendromuna neden olmasıyla oluşmaktadır. Bunun sonucunda, pulmoner yetmezlik ve peteşiyal hemorajik lezyonlar ve nörolojik belirtiler ortaya çıkmaktadır .19 yaşında erkek hasta araç dışı trafik kazası sonucu oluşan femur ve bilateral radius kırığı nedeniyle ortopedi kliniğine başvurdu. Ortopedi bölümü tarafından operasyonu planlanan hastanın preoperatif değerlendirilmesinde özellik yoktu. Trafik kazasından yaklaşık 32 saat sonra, hastanemize başvuran hastaya genel anestezi altında femur intramedüller çivileme ve bilateral radius kapalı redüksiyon+ K-teli ile fiksasyon operasyonu yapıldı. İntraoperatif ve anestezi sonrası bakım ünitesinde vitaller stabil seyretti. Postoperatif 20. Saatte akut mental durum değişikliği ve desatürasyon gelişmesi nedeni ile hasta entübe edilip yağ embolisi ön tanısı ile yoğun bakıma transfer edildi. Olgu, yoğun bakımda uygulanan destek ve medikal tedavi sonrası 4. günde ekstübe edidi, sonrasında serviste takip edilen hasta şifa ile taburcu edildi.
Fat embolism syndrome (FES) occurs when fat globules entering the circulation after injury disrupt the capillary bed and affect microcirculation, causing a systemic inflammatory response syndrome. As a result, pulmonary failure, petechial hemorrhagic lesions and neurologic symptoms occur (1,2). A 19-year-old male patient was admitted to the orthopedic clinic with a femur and bilateral radius fractures due to a non-vehicle traffic accident. The preoperative evaluation of the patient who was planned to be operated by the orthopedic department was unremarkable. Approximately 32 hours after the traffic accident, the patient admitted to our hospital and femur intramedullary nailing and bilateral radius closed reduction + K-wire fixation operation was performed under general anesthesia. Vital signs were stable intraoperatively and in the postanesthesia care unit. The patient was intubated and transferred to the intensive care unit with a prediagnosis of fat embolism due to acute mental status change and desaturation at the 20th postoperative hour. The patient was extubated on the 4th day after support and medical treatment in the intensive care unit and was followed up in the ward and discharged with healing.
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