Supportive care of right ventricular failure due to fat embolism syndrome

Pulmonary fat embolism is a common phenomenon in cases of traumatic long bone fractures, with only a minority developing the more catastrophic Fat Embolism Syndrome (FES). Diagnosis is clinical and requires a high index of suspicion. Treatment remains under-investigated, with common interventions having low quality level-of-evidence and no mortality benefit. In severe cases, focus should be on supporting the failing right ventricle through use of inotropes, pulmonary vasodilators, and mechanical circulatory support. This requires a thorough understanding of the unique physiology through the pulmonary circulation. •Pulmonary fat embolism is a common phenomenon following long bone fracture. Only a minority develop the more serious complication Fat Embolism Syndrome (FES).•FES is a diagnosis of exclusion classically characterized by hypoxemia, altered mentation, and petechiae. Mortality is often a result of right ventricular (RV) failure.•The failing RV has unique physiology. Treatment focuses on supportive care through use of inotropes, pulmonary vasodilators, and mechanical circulatory devices.