The effect of patient position during trauma surgery on fat embolism syndrome: An experimental study
Khalid A Syed1, Michael Blankstein2, Mohit Bhandari3, Masaki Nakane4, Radovan Zdero5, Emil H Schemitsch6
1 Division of Orthopaedic Surgery, Musculoskeletal Health and Arthritis Program, Toronto Western Hospital, Toronto, Canada
2 Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
3 Department of Clinical Epidemiology and Biostatistics, McMaster Health Sciences Centre, Hamilton, Canada
4 Department of Anesthesia, St. Michael's Hospital, Toronto, Canada
5 Martin Orthopaedic Biomechanics Laboratory, St. Michael's Hospital; Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, Canada
6 Department of Surgery, Faculty of Medicine, University of Toronto; Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, Canada
Biomechanics Lab, St. Michael's Hospital, Li Ka Shing Building (West Basement, Room B116), 209 Victoria Street, Toronto, ON, M5B-1W8
Source of Support: None, Conflict of Interest: None
Background: The aim of this study was to compare the effect of supine versus lateral position on clinical signs of fat embolism during orthopedic trauma surgery. Dogs served as the current study model, which could be extended and/or serve as a basis for future in vivo studies on humans. It was hypothesized that there would be an effect of position on clinical signs of fat embolism syndrome in a dog model.
Materials and Methods: 12 dogs were assigned to supine ( n = 6) and lateral ( n = 6) position groups. Airway pressures, heart rate, blood pressure, cardiac output, pulmonary artery pressure, pulmonary artery wedge pressure, right atrial pressure, arterial and venous blood gases, white blood count, platelet count and neutrophil count were obtained. Dogs were then subjected to pulmonary contusion in three areas of one lung. Fat embolism was generated by reaming one femur and tibia, followed by pressurization of the canal.
Results: No difference was found in any parameters measured between supine and lateral positions at any time (0.126 > P < 0.856).
Conclusions: The position of trauma patients undergoing reamed intramedullary nailing did not alter the presentation of the features of the lung secondary to fat embolism.