Arterial Blood Gas Analysis And Pulse Oximetry For Early Detection Of Fat Embolism Syndrome In Long Bone Fractures

Background: The occurrence of fat embolism with skeletal injury is very well known phenomenon. In most instances hypoxemia is sub clinical. The early diagnosis of those patients with low arterial oxygenation and subsequent initiation of respiratory support are essential of pulmonary dysfunction. Methods: Prospective analysis was conducted of 100 patients with isolated fractures of tibia, femur and multiple long bone fractures. All patients were examined with ABG on admission and monitoring of arterial saturation by pulse oximeter within 12 hours of injury and subsequently every 24 hours for 3 days. The saturation was monitored continuously in established cases of hypoxemia and also just before, during and after surgery. Results: Arterial hypoxemia with % SpO2 <94% as determined by pulse oxymeter occurred in 16/55 patients. Correlation of SpO2 with pulse oxymeter treading was done by linear regression analysis. Sub-clinical hypoxia was detected in early pre-operative period. Intra operative and post operative period had no correlation as patients were ventilated with oxygen supplementation. Conclusion: In the absence of specific clinical criteria to diagnose FES in early stages, ABG analysis is the only reliable method, but it is expensive, invasive, with limited accessibility and results in delays. Pulse oximetry is a useful non-invasive alternative and reasonable accurate method for early diagnosis of fat embolism syndrome.