Low-dose' corticosteroid prophylaxis against fat embolism

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Kallenbach J. Lewis M. Zaltzman M. Feldman C. Orford A. Zwi S. Journal of Trauma. [JC:kaf] 27(10):1173-6, 1987 Oct. Fat embolism remains a potentially life-threatening complication of skeletal *trauma.* The effect of "low-dose" corticosteroids on the incidence of fat embolism syndrome and isolated *arterial* hypoxemia was studied in 82 patients with skeletal *trauma,* i.e., fractures of the long bones of the lower extremities. In a strict alternate sequence, 40 patients were given methylprednisolone (total dosage, 9 mg/kg) and 42 received placebo from the time of admission. Fat embolism syndrome was diagnosed in 10 (23.8 per cent) placebo-treated patients, compared with 1 (2.5 per cent) steroid-treated patient. Isolated *arterial* hypoxemia developed in 44 patients; it was severe in 7 controls (21.9 per cent) and 1 (2.6 per cent) steroid-treated patient. The overall incidence of *arterial* hypoxemia was 67.1 per cent; 33 (78.6 per cent) controls were affected, compared with 22 (55 per cent) steroid-treated patients. The degree of hypoxemia was severe in 12 (28.6 per cent) controls, compared to 2 (5 per cent) steroid-treated patients. No patient with fat embolism syndrome died or required mechanical ventilation. One steroid-treated patient without fat embolism died of a fulminant infection. These results convincingly demonstrate the protective effects of relatively low doses of methylprednisolone against fat embolism and the *arterial* hypoxemia that follow skeletal *trauma.* However, the safety of this therapy requires further evaluation, particularly in the setting of wound contamination and immune-compromised states.