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Tetanus and its complications: intensive care and management experience in 150 Indian patients
F E Udwadia1, A Lall, Z F Udwadia
1Tetanus Ward, Sir J. J. Group of Teaching Hospitals, Bombay, India.
Insights
Intensive care and early interventions significantly reduced tetanus mortality from 30% to 12%. Key findings highlight managing complications like sudden cardiac arrest and hypoxemia in severe tetanus cases.
Area of Science:
- Medical Research
- Infectious Diseases
- Critical Care Medicine
Background:
- Tetanus poses significant mortality risks, particularly in resource-limited settings.
- Understanding complications and effective management strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To outline the complications of tetanus and management strategies.
- To evaluate the impact of intensive care and specific interventions on tetanus mortality.
- To identify factors contributing to mortality in severe tetanus cases.
Main Methods:
- Retrospective analysis of 150 tetanus patients treated between October 1983 and January 1986.
- Detailed observation of complications, including cardiovascular disturbances and respiratory issues.
- Evaluation of interventions such as intensive care, nutrition, tracheostomy, and ventilator support.
Main Results:
- Overall mortality reduced from 30% to 12% with intensive care and interventions.
- Mortality in severe tetanus cases decreased from 70% to 23%.
- Sudden death due to cardiac arrest, hypoxemia, bronchopulmonary infections, and sepsis were significant complications.
Conclusions:
- Intensive care, proper nutrition, early tracheostomy, and ventilator support are vital for reducing tetanus mortality.
- Monitoring for abrupt temperature rises is critical to prevent sudden death.
- Effective management of complications like hypoxemia, infections, and cardiovascular disturbances improves survival rates in tetanus.
Abstract:
A total of 150 patients were treated for tetanus in the tetanus ward of the J. J. Hospital, Bombay, between October 1983 and January 1986. The complications of tetanus and the mode of management in the presence of restricted resources are outlined. Intensive care, proper nutrition, early tracheostomy and ventilator support in severe tetanus were chiefly responsible for an overall reduction in mortality from 30 to 12%. The mortality in severe tetanus was reduced from 70 to 23%. Sudden death due to unexpected cardiac arrest was an important complication in severe tetanus. We observed that an abrupt marked rise in rectal temperature (greater than 107 degrees F, 41.7 degrees C), if undetected, could lead to sudden circulatory collapse and death. Well-marked hypoxaemia was observed in all patients with severe tetanus, and was related to ventilation perfusion inequalities and to an increase in the true venous admixture (increased Qs/Qt) in the lungs. Bronchopulmonary infections and the adult respiratory distress syndrome added significantly to morbidity and mortality. Autonomic cardiovascular disturbances included bradycardia alternating with tachycardia, and hypertension which was either labile, paroxysmal or sustained. Persistent hypotension was of ominous significance. Amongst numerous complications involving other systems, sepsis and septic shock were associated with a high mortality.