Tetanus - following up 285 patients in ICU

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Introduction

Tetanus is a toxic disease generally prevented by immunization, but it is still present in the Third World and it shows high mortality rate.

Objective

To evaluate morbidity and mortality of tetanic patients in ICU during 18 years of follow up.

Methods

This trial is an historical and a prospective cohort that studied 285 patients from October 1981 to October 1999. They were classified in two groups according to modified Ablett's scale: not severe (mild and moderate) tetanus and severe tetanus. The following variables were compared: incubation period (IP), onset period (OP), symptomatic period (SP), age, period of autonomic instability (AI), period of administration of benzodiazepine (Pbenzo), curare (Pcur), mechanical ventilation (PMV), clinical and infectious events and mortality during ICU follow up. In statistical analyses, the continuous variables were presented as the mean and standard deviation. Student t test was used to compare the two groups. The level of significance was P<0.05.

Results

This trial evaluated 71 patients with not severe tetanus and 214 patients with severe tetanus. The group with severe tetanus had a smaller IP and OP (P=0.002 and P=0.003, respectively), but a longer Pbenzo, Pcur and PMV (P=0.001) than the not severe group. There was no difference concerning the mean age between the two groups (P=0.26). The most common clinical events in tetanic patients were cardiorespiratory arrest (25.6%), pneumothorax (10.17%) and acute renal failure (10.17%). The incidence of respiratory, urinary and catheter infections were 76.14%, 38.24% and 7.71%, respectively. The mortality rates were 4.28% in not severe tetanus and 28.9% in severe tetanus (P<0.001).

Conclusions

The severe tetanus group presents a high mortality rate, probably as a result of autonomic instability, despite intensive care. Infections related to prolonged mechanical ventilation and invasive procedures were the most frequent events noticed in this study.