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Intensive Care Medicine

, Volume 21, Issue 12, pp 973–980 | Cite as

Contribution of bronchoalveolar lavage to the diagnosis of posttraumatic pulmonary fat embolism

  • O. Mimoz
  • A. Edouard
  • L. Beydon
  • J. Quillard
  • F. Verra
  • J. Fleury
  • F. Bonnet
  • K. Samii
Originals

Abstract

Objective

To verify whether the determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat inclusions is a useful diagnostic tool of posttraumatic pulmonary fat embolism.

Design

Prospective study.

Setting

Surgical Intensive Care Units in two university hospitals.

Patients

56 successive trauma patients needing prolonged postinjury mechanical ventilation, including 4 with clinical definite fat embolism syndrome, 5 in whom the diagnosis had been clinically suspected but was impossible to confirm or exclude before bronchoscopy, and 47 with no clinical evidence of the syndrome. Control groups included 8 patients without previous trauma who developed ARDS and 6 healthy surgical patients.

Methods

Bronchoalveolar lavage was performed within the first posttraumatic 3 days in trauma patients, at the beguining of the pulmonary disease in non trauma ARDS patients and just after anesthesic induction in healthy ortopedic patients. The magnitude of lipid content in alveolar cells was compared with the clinical pattern of the pulmonary fat embolism syndrome retrospectively evaluated at the seventh day postinjury in trauma patients.

Results

All the patients with definite fat embolism syndrome had more than 70% of lavage cells containing fat droplets. The group of patients in whom the diagnosis of the fat embolism syndrome was suspected had percentages of fat cells above 30% in 4 out of 5 patients. A percentage of fat cells above 30% was only observed in 7 out of the 47 patients without clinical evidence of the syndrome. The percentage varied between 0% to 35% in the group of non trauma ARDS patients and between 0 to 5% in healthy surgical patients.

Conclusion

Lipid inclusions in alveolar cells are common during traumatic and non-traumatic respiratory failure. Determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat droplets may contribute to the diagnosis of the fat embolism syndrome in mechanically-ventilated trauma patients with respiratory failure provided that the significant threshold would be 30%.

Key words

Bronchoalveolar lavage Fat embolism Trauma Lung injury Hypoxemia Intensive care unit 

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Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • O. Mimoz
    • 1
  • A. Edouard
    • 1
  • L. Beydon
    • 2
  • J. Quillard
    • 3
  • F. Verra
    • 4
  • J. Fleury
    • 5
  • F. Bonnet
    • 2
  • K. Samii
    • 1
  1. 1.Service d'Anesthésie-RéanimationUniversité de Paris Sud, Hôpital de BicêtreLe Kremlin BicêtreFrance
  2. 2.Service de Réanimation ChirurgicaleUniversité de Paris XII, Hôpital Henri MondorCréteilFrance
  3. 3.Service d'Anatomo-PathologieUniversité Paris Sud, Hôpital de BicêtreLe Kremlin BicêtreFrance
  4. 4.Service de Réanimation MédicaleUniversité de Paris XII, Hôpital Henri MondorCréteilFrance
  5. 5.Service d'Anatomo-PathologieUniversité de Paris XII, Hôpital Henri MondorCréteilFrance

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