Background FES is a rare complication of long bone fracture in children and adolescents. Mortality ranges from 1%-15%. Typical presentation: hypoxemia, neurological abnormality and petechial rash. FES and thoracic trauma are known causes of ARDS. NIMV is being increasingly used in respiratory failure.
Aim To report the intensive care management of a previously healthy 16-year-old male who developed severe ARDS.
Methods The patient was transferred to our Paediatric Intensive Care Unit, because of respiratory distress, 2 h after being submitted to intra medullary nailing of left femur, for a closed diaphyseal fracture post motorcycle accident. Upon admission, patient was oriented, hemodynamically stable and manifested hemoptysis and hypoxemic respiratory failure –pO2/FiO2 = 88,6 mmHg, Alveolar-arterial gradient (AaG)= 572 mmHg (normal= 5,9 mmHg)- not responding to supplemental O2 through a nonrebreathing face mask with reservoir. Chest X-ray: diffuse bilateral infiltrates. ECG and transthoracic echocardiogram : normal. Blood analysis: anaemia, thrombocytopenia, hypoalbouminemia, hypocalcaemia hypophosphatemia, CPK total 6870 IU/L (CK-MB normal) and d-Dimers 12450 (normal <500 ng/ml). Lower extremity ultrasound: normal. Spiral CT excluded pulmonary embolism, but was suggestive of fat embolism and inferior posterior segments contusions bilaterally. He responded to the use of NIMV (Pressure Support, PIP 22 cm H2O, Peep 10 cm H2O, FiO2 0.7) Petechial rash on trunk appeared later, confirming FES diagnosis. Additional treatment: RBC transfusion, methylprednisolone 60 mg/day, stress-ulcer prophylaxis, sbc LMWH, antibiotic and nutritional support.
Results Patient improved and was gradually weaned from NIMV 7 days later.
Conclusion NIMV has fewer complications and may be effective even in severe ARDS.