Outcome of Early Tracheostomy in the Management of Grade II (Moderate) Tetanus Patient

Awan, Nukhbat Ullah; Sohail, Muhammad Tariq; Sarwar, Zeeshan; Bashir, Muhammad; Khokhar, Muhammad Abbas; Chatha, Asad Aizaz

doi:10.21649/akemu.v23i4.2232

Cited by 2 publications

(3 citation statements)

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“…Other findings noted in this study that 67.9% (n=74) of our patients initially presented with severe stage tetanus, were similar with findings of previous studies that high mortality rate resulted from poor recognition of disease and delays in treatment. [5][6][7][8] Mortality rates in this study were still high at 52.3% (n=57), comparable to studies conducted in developing countries. [6][7][8] In addition, moderate to severe trismus 58.7% (n=64) was the predominant presenting symptom among study participants, comprising the primary indication for tracheostomy referral in our setting that was consistent with practices that avoid subsequent airway compromise once a patent tracheostomy was established.…”

Section: Discussionsupporting

confidence: 68%

“…[5][6][7][8] Mortality rates in this study were still high at 52.3% (n=57), comparable to studies conducted in developing countries. [6][7][8] In addition, moderate to severe trismus 58.7% (n=64) was the predominant presenting symptom among study participants, comprising the primary indication for tracheostomy referral in our setting that was consistent with practices that avoid subsequent airway compromise once a patent tracheostomy was established. 9,10 Only 35.8% (n=39) of our patients were admitted in an intensive care facility similar to findings of another local study, reflecting the limited resources and inadequate care for most of these patients.…”

Section: Discussionsupporting

confidence: 66%

“…However, the Awan et al study of 56 patients presenting with moderate trismus underscored early recovery and shorter length of hospital stay comparable to our study findings. 6,7 In addition, our study further revealed shorter length of mechanical ventilation among early tracheostomy with moderate stage tetanus compared with late tracheostomy but no significant difference was noted with severe tetanus.…”

Section: Discussionmentioning

confidence: 48%

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Timing of Tracheostomy and Outcomes in Adults with Moderate and Severe Tetanus

Espinosa¹,

Vinco²

2019

Philipp J Otolaryngol Head Neck Surg

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Objective: This study aimed to evaluate the timing of tracheostomy and relationship to outcomes (length of hospital stay, length of mechanical ventilation, morbidity and mortality rate) in adults with moderate and severe tetanus. Methods: Design: Cross-Sectional Study Setting: Tertiary Government Training Hospital Patients: All adult patients (19 years old and above) diagnosed with moderate and severe stage tetanus from January 2015 to January 2018 were considered for inclusion. Results: There were 109 patients included in this study, majority were males (n=95) with a male to female ratio of 7:1. Most belonged to the 51-60 years age group (mean: 53.7 SD: +/-16.1). Based on Cole Tetanus staging, the majority presented with severe stage tetanus (67.9%; n=74). Only 35.8% (n=39) were admitted at the Intensive Care Unit. Early tracheostomy was performed in 56.0% (n=61) of the patients (mean 6.3 hours SD: +/- 4.61). Mortality rate was noted to be 52.3% (n=57). Overall, early tracheostomy among moderate to severe stage tetanus patients showed shorter length of hospital stay and length of mechanical ventilation than late tracheostomy (tracheostomy >24 hours) (p-value < .05). However, no significant difference was noted for timing of tracheostomy in terms of morbidity and mortality rate (p-value > .05). Conclusion: Early tracheostomy within less than 24 hours from time of admission for moderate and severe tetanus is associated with shorter length of hospital stay and mechanical ventilation than late tracheostomy, and may play a role in tetanus management. Keywords: tracheostomy; tetanus; hospital stay; mechanical ventilation; morbidity; mortality

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Section: Discussionsupporting

confidence: 68%

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 48%

See 1 more Smart Citation

Timing of Tracheostomy and Outcomes in Adults with Moderate and Severe Tetanus

Espinosa¹,

Vinco²

2019

Philipp J Otolaryngol Head Neck Surg

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Current Concepts in the Management of Tetanus

Tkachenko

Shkatula

Badion

et al. 2020

EUMJ

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The study focuses on the problem of severe tetanus cases, which continue to be reported worldwide. The population of countries with low vaccination rates, including Ukraine, is particularly at risk. Despite the increase in the level of DPT vaccination in our country among adults and children, it remains insufficient, which leads to the registration of new cases of tetanus. The aim of the study was to analyze the main directions in the treatment of tetanus. The authors searched for information in electronic databases such as MEDLINE/Pub Med and Google Scholar for the last 20 years. The search was performed on such terms as tetanus, treatment, benzodiazepines, tetanus immunoglobulin (medical topics). The main components of modern treatment are analyzed in the paper, which include removal of the pathogen by careful surgical treatment of wounds, rational antibiotic therapy. Drugs of choice for the eradication of vegetative forms of the pathogen are benzylpenicillin and metronidazole, but can also be used antibacterial drugs of other groups (macrolides, tetracyclines, cephalosporins). Specific immunotherapy with tetanus immunoglobulin can neutralize the toxin that freely circulates in the blood. Those who do not have vaccination data are also indicated for the introduction of tetanus toxoid. Intrathecal administration of anti-tetanus immunoglobulin remains a debatable issue. In the treatment of convulsions, drugs of the benzodiazepine group are preferred. Infusions of high doses of magnesium, dexmetomedin, baclofen, propofol or their combination can also be used. In the case of severe muscular rigidity, muscle relaxants of nondepolarizing action are used. If the spasms are prolonged, botulinum toxin A may be recommended as an injection into peripheral muscles. B-blockers (esmolol), dexmetomedin, clonidine are used to overcome autonomic dysfunction of the nervous system. Supportive therapy is important. It is aimed at providing the patient with complete nutrition. Adequate ventilation with early tracheostomy helps to avoid complications of prolonged intubation. The above methods can significantly reduce mortality from tetanus from 100% (in the absence of treatment) to 10%–20%. Keywords: tetanus, management, benzodiazepines, magnesium sulfate, tetanus immunoglobin, tracheostomy.

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Outcome of Early Tracheostomy in the Management of Grade II (Moderate) Tetanus Patient

Cited by 2 publications

References 0 publications

Timing of Tracheostomy and Outcomes in Adults with Moderate and Severe Tetanus

Timing of Tracheostomy and Outcomes in Adults with Moderate and Severe Tetanus

Current Concepts in the Management of Tetanus

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