Tetanus in the adult: intensive care and management experience with 233 cases

Over a period of 10 years, 233 adult patients were treated for severe tetanus in this ICU. Criteria of severity, clinical patterns, and a detailed plan of treatment are outlined. The authors emphasize that such treatment implicates the permanent availability of trained personel in handling cardiorespiratory emergencies as well as prolonged mechanical ventilatory assistance in a specially designed environment (ICU). The form of therapy described herein seems to be the best currently available management regime, inasmuch as it can be expected to reduce significantly the notoriously high mortality associated with severe tetanus. Although this therapy is very expensive and time consuming, this is the price to be paid when the life of one of these patients is endangered. Complications are usually bizarre and unexpected. The authors found a high incidence of infectious respiratory complications, probably related to a change in the tracheal flora secondary to antibiotic therapy and a less than ideal care of tracheostomies. Unexpected cardiac arrest was the most common cardiovascular complication and also the most common cause of death; in the majority of these cases, a satisfactory explanation for this complication was not found, but it could have been related to overactivity of the autonomic nervous system.