Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical–epidemiological profile and risk factors for mortality

Nóbrega, Marcus Vinícius Dantas da; Reis, Ricardo; Aguiar, Isabel Cristina Veras; Queiroz, Timóteo Vasconcelos; Lima, Ana Cláudia Feitosa; Pereira, Eanes Delgado Barros; Ferreira, Raquel Feijó de Araújo

doi:10.1016/j.bjid.2016.06.007

Cited by 20 publications

(21 citation statements)

References 17 publications

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“…Comparison with contemporary data from other countries is more difficult due to limited reporting of established tetanus severity scores or known prognostic features. Nevertheless, the age of patients in our study (one of the strongest predictors of outcome) is similar to, or even older than, those reported in other centres with worse outcomes 10 , 18 , 19 . Similarly, our ventilation rate was 50% but rates between 50% and 75% elsewhere have been associated with mortality rates of 30–35% 10 , 19 , 20 .…”

Section: Discussionsupporting

confidence: 84%

“…With access to critical care interventions such as mechanical ventilation and advanced physiological monitoring, muscle spasms and autonomic nervous system dysfunction (ANSD) can be more easily managed [6][7][8] . These interventions are now available in many LMIC intensive care units (ICUs); however, their availability is often not associated with improved outcomes 9,10 .…”

Section: Introductionmentioning

confidence: 99%

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The management of tetanus in adults in an intensive care unit in Southern Vietnam

et al. 2021

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Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

The management of tetanus in adults in an intensive care unit in Southern Vietnam

et al. 2021

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“…Loan et al25 reported >90% of the patients with severe tetanus had pneumonia. Nobrega et al26 concluded that 84.8% of the patients had pneumonia. The incidence of pneumonia in our study was low.…”

Section: Discussionmentioning

confidence: 98%

<p>Clinical features and outcomes of tetanus: a retrospective study</p>

Zhao¹,

Wang²,

Zhang

et al. 2019

IDR

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Background: Tetanus is a serious disease resulting in muscle spasm, and even death. Methods: A retrospective, single-center study was conducted by analyzing demographic and clinical parameters. Results: The study included 12 males (70.6%) and 5 females (29.4%). The mean age of the patients was 56.71±9.05 years. Patient occupations included farming (47.0%), retired (23.5), homebound (23.5), and workers (6.0%). The causes of patient injuries were as follows: metal injury (52.9%), deep injury (29.4%), electrical injury (5.9%), maxillofacial region and knee injury (5.9%), and skin ulceration (5.9%). The disease duration ranged from 3 to 36 days, and the mean incubation period was 12.65±10.17 days. Four patients had co-morbidities. The infected patients were given tetanus antitoxin (TAT) and antibiotics treatment. One patient was given continuous renal replacement therapy (CRRT) and only one patient died. Conclusions: In our department, although tetanus is a serious disease, with effective treatment, patients have reasonable cure and low death rates.

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“…The blockage of neuromuscular transmission by the toxin causes painful muscle spasms and respiratory distress requiring ICU admission and mechanical ventilation (MV) in about 80% of patients [ 2 ]. Considering the long-lasting effect of the toxin, prolonged ventilation combined with sedation and neuromuscular blockade up to 6 weeks may be required [ 2 , 3 ]. In developing countries, where access to high intensity care may be a challenge, the mortality rate of tetanus has risen to 50% for a mean age of 50 years with little improvement over time [ 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Admission of tetanus patients to the ICU: a retrospective multicentre study

Mahieu¹,

Reydel²,

Maamar³

et al. 2017

Ann. Intensive Care

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Background An extended course of tetanus (up to 6 weeks) requiring ICU admission and protracted mechanical ventilation (MV) may have a significant impact on short- and long-term survival. The subject is noteworthy and deserves to be discussed.MethodsTwenty-two ICUs in France performed tetanus screenings on patients admitted between January 2000 and December 2014. Retrospective data were collected from hospital databases and through the registers of the town hall of the patients.ResultsSeventy patients were included in 15 different ICUs. Sixty-three patients suffered from severe or very severe tetanus according to the Ablett classification. The median age was 80 years [interquartile range 73–84], and 86% of patients were women. Ninety per cent of patients (n = 63) required MV for a median of 36 days [26–46], and 66% required administration of a neuromuscular-blocking agent for 23 days [14–29]. A nosocomial infection occurred in 43 patients (61%). ICU and 1-year mortality rates were 14% (n = 10) and 16% (n = 11), respectively. Forty-five per cent of deaths occurred during the first week. Advanced age, a higher SAPS II, any infection, and the use of vasopressors were significantly associated with a lower number of days alive without ventilator support by day 90. Age was the only factor that significantly differed between deceased and survivors at 1 year (83 [81–85] vs. 79 [73–84] years, respectively; p = 0.03). Sixty-one per cent of survivors suffered no impairment to their functional status.ConclusionIn a high-income country, tetanus mainly occurs in healthy elderly women. Despite prolonged MV and extended ICU length of stay, we observed a low 1-year mortality rate and good long-term functional status.

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Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical–epidemiological profile and risk factors for mortality

Cited by 20 publications

References 17 publications

The management of tetanus in adults in an intensive care unit in Southern Vietnam

The management of tetanus in adults in an intensive care unit in Southern Vietnam

<p>Clinical features and outcomes of tetanus: a retrospective study</p>

Admission of tetanus patients to the ICU: a retrospective multicentre study

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