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儿童法医尸检中骨髓内导管后脂肪栓塞。

Fat embolism after intraosseous catheters in pediatric forensic autopsies.

机构信息

University Center of Legal Medicine, chemin de la Vulliette n. 4, 1000, Lausanne, Switzerland.

University Center of Legal Medicine, rue Michel-Servet n. 1, 1206, Geneva, Switzerland.

出版信息

Int J Legal Med. 2023 May;137(3):787-791. doi: 10.1007/s00414-022-02848-4. Epub 2022 Jun 30.


DOI:10.1007/s00414-022-02848-4
PMID:35771256
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10085886/
Abstract

In our center, we performed the autopsy of a child who died from drowning and presented, at autopsy, a major pulmonary fat embolism (PFE). A cardiopulmonary resuscitation (CPR) was performed, including infusion by intraosseous catheter (IIC). No other traumatic lesions and diseases classically related to a risk of PFE were detected. According to some animal studies, we considered the IIC as the only possible cause for PFE. However, we could not find literature to confirm this hypothesis in humans, especially in a pediatric population. To verify the occurrence of PFE after IIC in a pediatric population, we retrospectively selected 20 cases of pediatric deaths autopsied in our center, in which a CPR was performed, without bone fractures or other possible causes of PFE: 13 cases with IIC (group A) and 7 cases without IIC (group B). Several exclusion criteria were considered. The histology slides of the pulmonary tissue were stained by Oil Red O. PFE was classified according to the Falzi scoring system. In group A, 8 cases showed PFE: 4 cases with a score 1 of Falzi and 4 cases with a score 2 of Falzi. In group B, no case showed PFE. The difference between the two groups was statistically significant. The results of our study seem to confirm that IIC can lead to PFE in a pediatric population and show that the PFE after IIC can be important (up to score 2 of Falzi). To the best of our knowledge, our study is the first specifically focused on the occurrence of PFE after IIC in a pediatric population by using autoptic data.

摘要

在我们中心,我们对一名溺水死亡并在尸检时表现出严重肺脂肪栓塞(PFE)的儿童进行了尸检。进行了心肺复苏术(CPR),包括经骨内导管(IIC)输注。未发现其他与 PFE 风险相关的创伤性病变和疾病。根据一些动物研究,我们认为 IIC 是 PFE 的唯一可能原因。然而,我们在人类中找不到文献来证实这一假设,尤其是在儿科人群中。为了在儿科人群中验证 IIC 后发生 PFE 的情况,我们回顾性选择了在我们中心进行尸检的 20 例儿科死亡病例,这些病例均进行了 CPR,没有骨折或其他可能导致 PFE 的原因:13 例使用了 IIC(A 组)和 7 例未使用 IIC(B 组)。考虑了几个排除标准。对肺组织的组织学切片进行油红 O 染色。根据 Falzi 评分系统对 PFE 进行分类。在 A 组中,有 8 例显示 PFE:Falzi 评分 1 有 4 例,Falzi 评分 2 有 4 例。在 B 组中,没有病例显示 PFE。两组之间的差异具有统计学意义。我们的研究结果似乎证实了 IIC 可导致儿科人群发生 PFE,并且表明 IIC 后发生的 PFE 可能很重要(高达 Falzi 评分 2)。据我们所知,我们的研究是第一项专门使用尸检数据研究儿科人群中 IIC 后发生 PFE 的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4661/10085886/4252220475d9/414_2022_2848_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4661/10085886/4252220475d9/414_2022_2848_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4661/10085886/4252220475d9/414_2022_2848_Fig1_HTML.jpg

相似文献

[1]
Fat embolism after intraosseous catheters in pediatric forensic autopsies.

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[2]
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[3]
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[7]
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[8]
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[9]
Pulmonary fat embolism after cardiopulmonary resuscitation.

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[10]
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引用本文的文献

[1]
The Relationship Between Non-Traumatic Fat Embolism and Fat Embolism Syndrome (FES) in Patients with Cancer.

Diseases. 2025-5-30

[2]
Correlation of pulmonary fat embolism with trauma and resuscitation in children.

Int J Legal Med. 2025-5-23

[3]
Fat embolism: a systematic review to facilitate the development of standardised procedures in pathology.

Histopathology. 2025-5

[4]
A diagnostic strategy for pulmonary fat embolism based on routine H&E staining using computational pathology.

Int J Legal Med. 2024-5

[5]
Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences.

J Pers Med. 2023-1-23

本文引用的文献

[1]
Fat Embolism, Fat Embolism Syndrome and the Autopsy.

Acad Forensic Pathol. 2019-9

[2]
Use of Intraosseous Needles in Neonates: A Systematic Review.

Neonatology. 2019-10-28

[3]
Fat Embolism Syndrome in a Child with Sickle Cell Disease.

J Pediatr. 2019-11

[4]
Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation.

Forensic Sci Med Pathol. 2019-3

[5]
Acute Chest Syndrome in Children with Sickle Cell Disease.

Pediatr Allergy Immunol Pulmonol. 2017-12-1

[6]
Fat Intravasation from Intraosseous Flush and Infusion Procedures.

Prehosp Emerg Care. 2015

[7]
Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use.

Anesth Analg. 2009-11-6

[8]
Intraosseous drug administration in children and adults during cardiopulmonary resuscitation.

Ann Pharmacother. 2007-10

[9]
[ON PULMONARY FAT EMBOLISM AFTER INJURIES WITH DIFFERENT PERIODS OF SURVIVAL].

Munch Med Wochenschr. 1964-5-22

[10]
Intraosseous infusion and pulmonary fat embolism.

Pediatr Crit Care Med. 2001-1

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