Management of traumaticasphyxia

Background: Traumatic asphyxia (TA) is a clinical syndrome associated with cervicofacial cyanosis, edema-petechiae, subconjunctival hemorrhage, and neurological symptoms following a sudden, severe compressive and blunt thoracoabdominal trauma. This syndrome is also called “acute thoracic compression syndrome”, “ecchymotic mask”, or “Perthez syndrome”. The syndrome is an uncommon but it can potentially lead to serious clinical consequences.
Method: Among 568 blunt thoracic trauma patients, we retrospectively evaluated a total of 12 patients for the diagnosis of TA in our department between February 2010 and February 2017. All patients were male with a mean age of 44,5 ± 15,6 (18-64 years)
Results: The patients were admitted to various types of trauma: Four (33%) motorcycle accidents, three (25%) car crashes, two (16%) industrial accidents, one (8%) farm accident, one (8%) mining accident and one (8%) truck accident. The most common accompanying pathology was pneumothorax -hemopneumothorax in seven (58%) patients and tube thoracostomy was performed. Other accompanying traumatic pathologies were rib fractures in five patients, sternal fracture in one, pelvis and upper extremity fractures in one, clavicular fracture in one, cephalic haematoma in one and, pulmonary contusion in one. All patients were treated as conservatively. In three (25%) of the patient neurological findings were developed as agitation, disorientation and loss of consciousness during follow. These findings regressed after supportive conservative treatment within days. The mean time of length of hospital stay was 6 ± 2, 9 days (4-15 days). There was no mortality.
Conclusion: Traumatic asphyxia is a rare syndrome after blunt thoracic trauma. In the majority of cases supportive conservative therapy as head elevation of 30 degrees, continuous oxygen therapy and close follow up in terms of neurological and other complications may be sufficient for the management of the syndrome. However, injuries associated with trauma must be kept in mind and these injuries should be appropriately treated.