Fat Embolism Research Articles

Epidemiology and risk factors for fat embolism in isolated lower extremity long bone fractures.

Fat embolism syndrome (FES) is a serious complication after orthopedic trauma. The aim of this study was to identify risk factors for FES in isolated lower extremity long bone fractures. The National Trauma Data Bank "NTDB" study included patients with isolated femoral and tibial fractures. A total of 344 patients with FES were propensity score matched with 981 patients without FES. Multivariate logistical regression was used to identify independent risk factors for FES. FES was diagnosed in 344 (0.03%) out of the 1,251,143 patients in the study populations. In the two matched groups, the mortality was 7% in the FES group and 1% in the No FES group (p < 0.001). FES was associated with an increased risk of ARDS, VTE, pneumonia, AKI, and stroke. Younger age, femur fractures, obesity, and diabetesmellitus were independent predictors of FES. Early operative fixation (≤ 48h) was protective against FES. FES increases mortality by seven times. Young age, obesity, and diabetesmellitus are significant independent risk factors for FES. Early fixation is independently associated with a reduced risk of FES. Level III. Prognostic study.

B-ultrasound-assisted gluteal fat grafting in Asians: A prospective study of quantitative results from three-dimensional imaging and B-ultrasound analysis

BackgroundThe increasing number of fatalities caused by gluteal fat grafting is concerning; thus, there is a need to determine ways to obtain the ideal aesthetic effect while ensuring a safe operation. In this study, three-dimensional (3D) measurements combined with B-ultrasound were used to evaluate the effect of gluteal fat augmentation in Asians, whose safety and effectiveness were confirmed using quantitative data. MethodsThirty-five consecutive female patients were evaluated in this prospective clinical study. All patients underwent B-ultrasound-assisted gluteal fat augmentation on the subcutaneous plane alone. 3D imaging and B-ultrasound analysis of the adipose tissue thickness in the gluteal region were performed preoperatively and at 1 week, 3 months and 6 months post-operatively. ResultsThe waist circumference of the patients decreased, gluteal circumference and length of the gluteal crease increased and average waist-to-hip ratio improved from 0.78 to 0.74. At 3 months and 6 months post-operatively, the adipose tissue thickness decreased by 5.1% and 15.1%, respectively. The fat retention rates calculated using 3D imaging measurements at 3 months and 6 months post-operatively were 77.9% and 64.7%, respectively. According to the BODY-Q scale scores, patients reported a high level of satisfaction post-operatively. ConclusionsB-ultrasound guidance can effectively prevent the occurrence of fatal fat embolism during gluteal fat grafting and maximise the augmentation effect. The quantitative data obtained using 3D measurements and B-ultrasound confirmed the safety and effectiveness of fat injections for gluteal augmentation under B-ultrasound guidance.

Paediatric Association of Nigeria Guidelines on the Management of Acute Chest Syndrome in Children with Sickle Cell Disease (2023)

Acute Chest Syndrome (ACS) is a major cause of hospitalisation, a potentially life-threatening complication and a leading cause of mortality in children with Sickle Cell Disease (SCD). The affected child commonly presents with respiratory symptoms such as cough, breathlessness, chest pain, jitteriness, and confusion, with or without fever. The cause of this condition is multifactorial and sometimes unidentified, but the majority are due to infection, infarction, and fat embolism. ACS and its related complications may be minimised by prompt intervention and appropriate therapy, including the use of incentive spirometry and blood transfusion.&#x0D; &#x0D; Objective&#x0D; The development of a national guideline on the management of ACS in children with SCD under 18 years in Nigeria is meant to enhance early diagnosis and prompt treatment of ACS to improve the quality of care and clinical outcome and prevent death from ACS. It is intended to enhance the clinician's diagnostic capability and ensure that children with ACS receive the best available care.&#x0D; &#x0D; Methods&#x0D; This evidence-based guideline was adapted from the British Society of Haematology (BSH) and the American Society of Hematology (ASH) guidelines using the ADAPTE (Resource tool kit version 2.1) and AGREE II methods.&#x0D; &#x0D; Results&#x0D; The PAN Guideline Panel reached a consensus on 25 recommendations, three of which were modified and adapted for local use. The recommendations reflect a broad definition of ACS and a management approach, including blood transfusion and incentive spirometry, such as blowing latex balloons in the absence of a spirometer.&#x0D; &#x0D; Conclusions&#x0D; Most recommendations are conditional because of low-certainty evidence and closely balanced benefits and harms (benefits of therapy to patients and availability of such therapy). Patient preferences should drive clinical decisions. Randomised controlled trials and comparative-effectiveness studies are needed for optimal management of blood transfusion, fluid therapy, and use of oxygen.

Cervical Spinal Cord Infarction as a Rare Complication of Fat Embolism Syndrome Due to Orthopedic Trauma (P8-5.025)

Cervical Spinal Cord Infarction as a Rare Complication of Fat Embolism Syndrome Due to Orthopedic Trauma (P8-5.025)

Cerebral Fat Embolism due to Sickle Cell Crisis with Concurrent Parvovirus B-19 Infection (P11-13.010)

Cerebral Fat Embolism due to Sickle Cell Crisis with Concurrent Parvovirus B-19 Infection (P11-13.010)

Death from Fat Embolism after Lipectomy in a Patient with Madelung’s Disease

Death from Fat Embolism after Lipectomy in a Patient with Madelung’s Disease

Enhancing Safety in Tumescent Liposuction: Managing Sedation-Related Respiratory Issues and Serious Complications Under Deep Sedation with the Propofol-Ketamine Protocol.

Over the past 4years, aesthetic surgery, notably liposuction, has substantially increased. Tumescent liposuction, a popular technique, has two variants-true tumescent liposuction (TTL) and semi-tumescent liposuction. While TTL reduces risks, it has limitations. There is no literature reported on semi-tumescent liposuction under deep sedation using the propofol-ketamine protocol, which is proposed as a potentially safe alternative. The retrospective analysis covered 8years and included 3094 patients performed for tumescent liposuction under deep sedation, utilizing the propofol-ketamine protocol. The evaluation of patient safety involved an examination of potential adverse events with a specific focus on respiratory issues related to sedation, including instances of mask ventilation. Among the 3094 cases, no fatalities were recorded. Noteworthy events included 43 mask ventilation instances, primarily occurring in the initial 10 min. Twelve cases experienced surgery cancellation due to various factors, including respiratory issues. Three patients were transferred to upper-level hospitals, while another three required blood transfusions. Vigilant management prevented significant complications, and other adverse events like venous thromboembolism (VTE), fat embolism, severe lidocaine toxicity, and so on were not observed. The analysis of 3094 tumescent liposuction cases highlighted the overall safety profile of the propofol-ketamine protocol under deep sedation. The scarcity of severe complications underscores its viability. The study emphasizes the significance of thorough preoperative assessments, careful patient selection, and awareness of potential complications. Prompt interventions, particularly in addressing sedation-related respiratory issues, further contribute to positive outcomes for patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical manifestation and imaging diagnostic analysis of fat embolism syndrome

To explore characteristics of clinical and imaging findings in patients with fat embolism syndrome. From January 2021 to October 2022,clinical manifestations of 13 patients with fat embolism due to fracture or orthopaedic surgery were retrospectively analyzed,including 11 males and 2 females,aged from 17 to 60 years old. Mental and respiratory abnormalities and changes in vital signs occurred after admission or after surgery,and patient's chest and brain imaging results were abnormal. The patient's mental and respiratory abnormalities,vital signs,chest and brain imaging results were continuously monitored. The main clinical manifestations of fat embolism syndrome were abnormal pulmonary respiration in 13 patients,abnormal central nervous function in 7 patients,and spotted rash in 2 patients. Chest CT showed diffuse distribution of ground glass shadows in 13 patients,and severe symptoms were "snowstorm". Nine patients with ground glass fusion consolidation,5 patients with multiple nodules and 4 patients accompanied by bilateral pleural effusion. Head CT findings of 5 patients were negative,and head MRI findings of 1 patient showed multiple T1WI low signal,T2WI high signal shadow,DWI high signal shadow,and "starry sky sign" in basal ganglia,radiative crown,hemioval center,thalamus,frontal parietal cortex and subcortex. Fat embolism syndrome has a high mortality rate. Clinical manifestations of respiratory system and nervous system are not specific,and the skin spot rash has a characteristic manifestation. The "blizzard" sign is the specific manifestation of chest X-ray and CT examination of fat embolism,and the "starry sky" sign is the typical manifestation of diffusion-weighted sequence of brain MRI examination of fat embolism.

Pulmonary fat embolism in non-survivors after cardiopulmonary resuscitation

BackgroundBlunt trauma acting against the human body presents the fundamental cause of pulmonary fat embolism (PFE) and fat embolism syndrome. The aim of the present study was to investigate PFE in non-survivors after cardiopulmonary resuscitation (CPR). MethodsThis was a prospective cohort study conducted in University Hospital Ostrava, Czech Republic. Within a 4-year study period, all non-survivors after CPR because of out-of-hospital cardiac arrest were assessed for the study eligibility. The presence/seriousness of PFE was determined by microscopic examination of cryo-sections of lung tissue (staining with Oil Red O). ResultsIn total, 106 persons after unsuccessful CPR were enrolled in the study. The most frequent cause of death in the study population (63.2% of cases) was cardiac disease (ischemic heart disease); PFE was not determined as the cause of death in any of our study cases. Sternal fractures were identified 66.9%, rib fractures (usually multiple) in 80.2% of study cases; the median number of rib fractures was 10.2 fractures per person. Serious intra-thoracic injuries were found in 34.9% of cases.Microscopic examination of lung cryo-sections revealed PFE in 40 (37.7%) study cases; PFE was most frequently evaluated as grade I or II. Occurrence of sternal and rib fractures was significantly higher in persons with PFE than between persons without PFE (p = 0.033 and p = <0.001). Number of rib fractures was also significantly higher in persons with PFE. The occurrence of serious intra-thoracic injuries was comparable in both our study groups (p = 0.089). ConclusionsPFE presents a common resuscitation injury which can be found in more than 30% of persons after CPR. Persons with resuscitation skeletal chest fractures have significantly higher risk of PFE development. During autopsy of persons after unsuccessful CPR, it is necessary to distinguish CPR-associated injuries including PFE from injuries that arise from other mechanisms.

Endovascular Treatment as an Alternative to Bypass Surgery for Juxtarenal Aortic Occlusion: Results from the CHAOS (CHronic Abdominal Aortic Occlusion, ASian Multicenter) Registry

Juxtarenal aortic occlusion (JRAO), in which the occlusion of the aorta extends to just below the renal artery, is often treated by bypass surgery because of concerns about the risk of procedural failure and fatal embolization to abdominal organs when treated with endovascular treatment (EVT). This study assessed the outcome of EVT for JRAO compared with aorto-biiliac /aorto-bifemoral (AOB) or axillo-bifemoral (AXB) bypass. A retrospective review of an international database created by 30 centers in Asia (CHronic Abdominal Aortic Occlusion, ASian Multicenter registry) was performed for patients who underwent revascularization for chronic total occlusion of the infrarenal aorta from 2007 to 2017. Of the 436 patients, 130 with JRAO (Forty-seven AOBs, 32 AXBs, and 51 EVTs) from 25 institutions were included in this study. Patients were significantly older in the AXB and EVT groups and more malnourished in the EVT group than the AOB group. EVT was attempted but failed in 1 patient. Seven patients (1 [2.1%] in the AOB group, 1 [3.1%] in the AXB group, and 5 [9.8%] in the EVT group) died during hospitalization, but most of the causes in the EVT group were not related to the revascularization procedure. No visceral embolism was observed, which had been concerned, even though protection was performed only in 2 cases of the EVT group. At the latest follow-up (median duration 3.0years), the ankle-brachial pressure index was significantly higher in the order of AOB, EVT, and AXB. At 4years, the estimated primary and secondary patency rates of the AOB group (87.5% and 90.3%, respectively) were significantly higher than the AXB group (66.7% and 68.6%, respectively). AOB remains the gold standard and should be the first choice for acceptable risk patients. For frail patients, EVT is a good option and likely preferable as a first-line treatment compared to AXB.

Stroke without cerebral arteriopathy in sickle cell disease children: causes and treatment.

Cerebral arteriopathy (CA) in children with sickle cell disease (SCD) is classically described as chronic stenosis of arteries in the anterior brain circulation, leading to ischemic stroke. Some studies have, however, reported strokes in children with SCD but without CA. In order to better understand the etiology and risk factors of these strokes, we retrospectively analyzed ischemic strokes occurring in a large cohort of children over a 13-year period. Between 2007 and 2020, 25 of 1,500 children with SCD had an ischemic stroke in our center. Among them, 13 (52%) had CA, described as anatomical arterial stenosis, while 12 (48%) did not. Patients with stroke without CA were older than patients with stroke attributed to SCD-CA (9.0 years old vs. 3.6 years old; P=0.008), and more frequently had SC genotype (25% vs. 0%, respectively). Their strokes more frequently involved the posterior circulation, with cerebellar involvement in 42%. Retained stroke etiologies in patients without typical SCD-related CA were reversible cerebral vasoconstriction syndrome, cerebral fat embolism, arterial thrombosis or thromboembolism, hyperviscosity, vasculitis in a context of infectious meningo-encephalitis, and severe hemodynamic failure. No recurrence was observed in the 24 months following stroke, even though 67% of the patients in this group were no longer receiving exchange transfusions. In conclusion, in a cohort of pediatric SCD patients with an efficient stroke screening strategy, half of the ischemic strokes that occurred were related to causes other than CA. They affected a different population of SCD children and systematic long-term transfusion programs may not be necessary in these cases.

Fat transfer principles and applications in plastic surgery: a literature review

Fat transfer of fat grafting is a renowned technique in plastic surgery, in which harvested fat tissue is injected beneath the skin into part of the body to be reconstructed. The fat transfer technique is the most popular choice for reconstructive and cosmetic procedures due to its low immunogenicity, low cost, and ease of access. In cosmetic, reconstructive plastic surgery, the fat transfer procedure is done by moving fat tissue from one body part to another body part. It consists of five main procedures: harvesting fat tissue, processing fat tissue, determining the recipient location, transferring or grafting fat tissue, and retaining or surviving the graft/fat transfer results. Procedures for fat transfer are typically done on the face, breasts, and buttocks. Fat transfer can lead to many consequences, such as skin issues, hematomas, infections, seromas, and even fatal fat emboli. This literature review aims to explain the principles of fat transfer and their applications in plastic surgery.

Patient Safety: Ultrasound-Assisted Buttock Fat Grafting for the Effectiveness of Aesthetic Results

A systematic review of the literature was carried out, whose basis is the structured and systematic integration of the information obtained in different research studies published in specialized journals, which was a search of records in the following databases: PubMed, SciELO and Science Direct of studies published in the last 10 years (2013-2023). The articles were searched in English and Spanish, Portuguese and once selected, they were read, with the due concentration of relevant information for this research. Two independent reviewers screened publications including those showing or not showing clinical evidence for "Ultrasound-assisted buttock fat grafting for the effectiveness of aesthetic outcomes ." We included 4 studies that met our selection criteria. We extracted data from: year of publication, author, country, population and outcomes. Conclusion: The use of real-time ultrasound allows injection into the subcutaneous plane of the skin, avoiding the deep plane where life-threatening complications such as fat embolism could occur.

In vivo study to assess fat embolism resulting from the Reamer-Irrigator-Aspirator 2 system compared to a novel aspirator-based concept for intramedullary bone graft harvesting

IntroductionFat embolism (FE) following intramedullary (IM) reaming can cause severe pulmonary complications and sudden death. Recently, a new harvesting concept was introduced in which a novel aspirator is used first for bone marrow (BM) aspiration and then for subsequent aspiration of morselized endosteal bone during sequential reaming (A + R + A). In contrast to the established Reamer-Irrigator-Aspirator (RIA) 2 system, the new A + R + A concept allows for the evacuation of fatty BM prior to reaming. In this study, we hypothesized that the risk of FE, associated coagulopathic reactions and pulmonary FE would be comparable between the RIA 2 system and the A + R + A concept.Materials and methodsIntramedullary bone graft was harvested from intact femora of 16 Merino sheep (age: 1–2 years) with either the RIA 2 system (n = 8) or the A + R + A concept (n = 8). Fat intravasation was monitored with the Gurd test, coagulopathic response with D-dimer blood level concentration and pulmonary FE with histological evaluation of the lungs.ResultsThe total number and average size of intravasated fat particles was similar between groups (p = 0.13 and p = 0.98, respectively). D-dimer concentration did not significantly increase within 4 h after completion of surgery (RIA 2: p = 0.82; A + R + A: p = 0.23), with an interaction effect similar between groups (p = 0.65). The average lung area covered with fat globules was similar between groups (p = 0.17).ConclusionsThe use of the RIA 2 system and the novel A + R + A harvesting concept which consists of BM evacuation followed by sequential IM reaming and aspiration of endosteal bone, resulted in only minor fat intravasation, coagulopathic reactions and pulmonary FE, with no significant differences between the groups. Our results, therefore, suggest that both the RIA 2 system and the new A + R + A concept are comparable technologies in terms of FE-related complications.

Gluteal Fat Grafting Technique and Mortality Update Among Surveyed ABCS Surgeons

Background: The demand for gluteal fat grafting (colloquially known as Brazilian butt lift [BBL]) has seen a dramatic increase in the past decade. Brazilian butt lift has been the fastest-growing cosmetic procedure in the United States for several years. During this time, the incidence of pulmonary fat embolisms (PFEs) associated with this procedure has raised safety concerns. Several professional organizations have responded to these concerns with investigational reports to identify the causes and provide recommendations to decrease the mortality associated with this popular cosmetic procedure. Awareness and implementation of these safety recommendations have been a cornerstone to decreasing the mortality rate associated with gluteal fat grafting. Objectives: To provide a comparison of current technical approaches and a mortality update on gluteal fat grafting among surgical members from the American Board of Cosmetic Surgeons (ABCS) within the last 6 years. Also, to determine if specific technical changes in the manner this procedure is performed are improving safety. Methods: An online (emailed) survey regarding perioperative gluteal fat grafting techniques and postoperative outcomes performed by ABCS surgeons within the previous 3 years was collected in 2 different 3-year time frames. Initial data were collected in 2019 for the preceding 3 years 2016-2019. The survey was again repeated in 2022 to collect similar data as before from ABCS member years 2019-2021. The data, which included the total # of BBLs performed, incidence of major infection or fat emboli, cannula size, and injection methods details was compared for each 3-year period. Both sequential studies provided a comparison of the techniques employed as well as morbidity and mortality outcomes. Results: Sixty-four ABCS surgeons who reported performing BBLs responded to the survey in 2019 and reported performing a total of 22 800 (BBLs) gluteal fat grafting cases in a previous 3-year window from 2016 to 2018. More surgeons used a closed system peristaltic pump in the second part of the study as compared to the first (51% vs 22%) ( P &lt; .01). Two cases required in-hospital treatment of infection in the first survey while zero cases were reported for the second survey period ( P = .07). Twenty-five of 64 (39%) reported injecting fat at least into superficial gluteal muscle during this earlier time frame. In this earliest study, there were 3 total cases of PFE reported (2 fatal PFEs and 1 nonfatal PFEs). In 2022, 85 ABCS surgeons who reported performing BBLs responded to the survey. Around 12 172 gluteal fat grafting cases were reported in the second 3-year study from 2019 to 2021 compared to 22 800 in the first study ( P &lt; .01). There was a total of 34 972 BBLs during the entire 6-year study. Most surgeons (82 of the 85) in the second-phase 3-year study reported injecting fat “exclusively” above the muscle ( P &lt; .01). There were no fatal and non-fatal PFEs reported in the follow-up 3-year study in 2022 of ABCS member data from 2019 to 2021 ( P = .03). Conclusions: The mortality report associated with gluteal fat grafting from this survey among surgical members of the ABCS suggests using the current safety recommendations proposed, including injection of fat in the subcutaneous layer only, have led to a decreased risk of PFEs associated with gluteal fat grafting. The mortality rate was zero (0 out of 12 800) when 96% were injecting above muscle only compared to a mortality rate of 1:11 400 (2 of 22 800 cases) when 39% of 22 800 BBLs performed had fat injected into muscle. While there were more BBLs performed during the earlier 3-year study ( P = .07). The mortality rate significantly decreased in the years when only a small minority of cases had fat injected into the muscle. This study adds to other existing literature from professional organizations’ reports on the safety of gluteal fat grafting using the proper safety measure and recommendations.

Venous Thrombosis and Thromboembolism of Pulmonary Artery in Plastic Surgery: Risk Factors, Course Options and Therapeutic Strategies

A detailed analysis of the literature was carried out and an analysis of our own clinical case of managing a patient with thrombosis of the veins of the lower extremities and thromboembolism of the pulmonary arteries, which developed after the procedure of abdominoplasty and liposuction, is presented. There are limited descriptions of thromboembolic events and their treatment after abdominoplasty and/or liposuction in the literature. The article summarizes modern mechanisms of development and variants of the course of venous thrombosis, pulmonary embolism and pulmonary fat embolism in plastic surgery, as well as approaches to the management of such patients, with special attention paid to the interdisciplinary approach.

Fat Emboli with Thrombocytopenia in A Patient Undergoing Operation for A 1/3 Medial Humerus Oblique Fracture

Fat embolism is a clinical syndrome characterized by the systemic spread of fat emboli which often occurs due to fractures in long bones. We report a 29 year old man with a diagnosis of a fracture of the medial third of the right humerus accompanied by thrombocytopenia which could be one of the clinical manifestations of pulmonary embolism. A 29 year old man came to the emergency room at RAA Soewondo Pati Regional Hospital with complaints of pain in his right hand 2 hours before entering the hospital. The patient felt pain after falling and slipping at home. Physical examination revealed tachycardia and tachypnea. Humeral x-ray revealed discontinuity in the medial 1/3 of the right humerus. The patient then underwent treatment for the fracture and the day after a routine blood test was carried out. Routine blood tests revealed thrombocytopenia.Fat embolism is a dangerous complication of long bone fractures. Often this fat embolism is not recognized until the patient shows symptoms in several systems, especially the respiratory system such as respiratory distress and neurological system disorders ranging from motor disorders to seizures. Apart from that, fat embolism can also disrupt the coagulation system so that thrombocytopenia can occur. In this patient there was tachypnea and thrombocytopenia which could be early symptoms of fat embolism. Fat embolism is a complication of long bone fractures that is rare but dangerous if not properly recognized. Immediate management of fractures and collaboration with anesthesiologists and internists are important to prevent fat embolism.

Complications of facial autologous fat grafting

Autologous fat grafting is a commonly performed procedure for facial volume augmentation and rejuvenation. While overall complication rates in the literature are low, adverse events related to fat grafting can range from minor to systemic and severe. It is crucial that the surgeon be aware of these potential complications, counsel patients appropriately, and take the necessary steps to mitigate these risks. Local graft site complications include contour irregularity, over- or under-volumization, prolonged edema and ecchymosis, fat necrosis, granuloma formation, and infection. Similar complications can also be seen at the donor sites, including contour irregularity, prolonged induration or erythema, infection, and skin pigmentation changes. Finally, the most severe complications, resulting from fat embolism due to intravascular injection, can result in vision loss or stroke. In this review, risk factors for adverse events, surgical techniques to mitigate risk, and potential treatment options for complications of autologous fat grafting are reviewed.

Deaths of U.S. Citizens Undergoing Cosmetic Surgery - Dominican Republic, 2009-2022.

Although infections resulting from cosmetic surgery performed outside the United States have been regularly reported, deaths have rarely been identified. During 2009-2022, 93 U.S. citizens died after receiving cosmetic surgery in the Dominican Republic. The number of deaths increased from a mean of 4.1 per year during 2009-2018 to a mean of 13.0 during 2019-2022 with a peak in of 17 in 2020. A subset of post-cosmetic surgery deaths occurring during peak years was investigated, and most deaths were found to be the result of embolic events (fat emboli or venous thromboembolism) for which a high proportion of the patients who died had risk factors, including obesity and having multiple procedures performed during the same operation. These risk factors might have been mitigated or prevented with improved surgical protocols and postoperative medical care, including prophylactic measures against venous thromboembolism. U.S. citizens interested in receiving elective cosmetic surgery outside the United States should consult with their health care professionals regarding their risk for adverse outcomes. Public health authorities can support provider education on the importance of preoperative patient evaluation and the potential danger of performing multiple cosmetic procedures in one operation.

The Na/K-ATPase role as a signal transducer in lung inflammation.

Acute respiratory distress syndrome (ARDS) is marked by damage to the capillary endothelium and alveolar epithelium following edema formation and cell infiltration. Currently, there are no effective treatments for severe ARDS. Pathologies such as sepsis, pneumonia, fat embolism, and severe trauma may cause ARDS with respiratory failure. The primary mechanism of edema clearance is the epithelial cells' Na/K-ATPase (NKA) activity. NKA is an enzyme that maintains the electrochemical gradient and cell homeostasis by transporting Na+ and K+ ions across the cell membrane. Direct injury on alveolar cells or changes in ion transport caused by infections decreases the NKA activity, loosening tight junctions in epithelial cells and causing edema formation. In addition, NKA acts as a receptor triggering signal transduction in response to the binding of cardiac glycosides. The ouabain (a cardiac glycoside) and oleic acid induce lung injury by targeting NKA. Besides enzymatic inhibition, the NKA triggers intracellular signal transduction, fostering proinflammatory cytokines production and contributing to lung injury. Herein, we reviewed and discussed the crucial role of NKA in edema clearance, lung injury, and intracellular signaling pathway activation leading to lung inflammation, thus putting the NKA as a protagonist in lung injury pathology.