Īs critical care services improve throughout the world, the capacity to manage severe tetanus is increasing and some centres have reported significant reductions in mortality rates. Tetanus is a vaccine-preventable disease associated with severe muscle spasm and cardiovascular system disturbance that remains a common cause of acute critical illness in low- and middle-income countries (LMICs).
Risk factors for reduced physical function at 3 months and 6 months post discharge suggest that modifiable features during hospital management are important determinants of long-term outcome. MV and ANSD may be suitable endpoints for future research. Age, female sex, admission systolic blood pressure, admission SpO 2, MV, ANSD, midazolam requirement, hospital-acquired infection, pressure ulcer and duration of ICU and hospital stay were associated with reduced 0.25 quantile PCS at 6 months after hospital discharge.
Median PCS at hospital discharge, 3 and 6 months were 32.37 and 54.8, respectively. Heart rate, SpO 2 and time from first symptom to admission were associated with ANSD (OR 1.03, p < 0.01 OR 0.95, p = 0.04 and OR 0.64, p < 0.01, respectively). ResultsĪge, temperature, heart rate, lower peripheral oxygen saturation (SpO 2) and shorter time from first symptom to admission were associated with MV (OR 1.03, p = 0.04 OR 2.10, p = 0.04 OR 1.04, p = 0.02) OR 0.80, p = 0.02 and OR 0.65 [95% CI 0.52, 0.79, p < 0.001, respectively). Physical function component scores (PCS), calculated from Short Form Health Survey (SF-36), were assessed in 79 patients at hospital discharge, 3 and 6 months post discharge. MethodsĬlinical and demographic variables were collected prospectively from 180 adults with tetanus. In this study, we investigate risk factors for disease severity and long-term physical outcome in adults with tetanus admitted to a Vietnamese intensive care unit. Understanding factors associated with worse outcome in such settings is important to direct interventions. Nevertheless, patients develop severe syndromes associated with autonomic nervous system disturbance (ANSD) and the requirement for mechanical ventilation (MV). Tetanus remains common in many low- and middle-income countries, but as critical care services improve, mortality from tetanus is improving.
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