Clinical profile of adult tetanus patients and the impact of early tracheostomy on the outcome; a retrospective observational study

  • Arshi Naz Department of Anesthesiology, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan.
  • Ghulam Rasheed Dr. Ziauddin Hospital, Clifton Campus, 4/B Shahrah-e-Ghalib Road, Block 6 Clifton, 75600, Karachi, Pakistan.
  • Zahid Akhtar Rao Department of Anesthesiology & Critical Care, Fazaia Ruth Pfau Medical College, Main Shahrah–e–Faisal, PAF Faisal Base, Karachi, Pakistan.
  • Sana Urooj Department of Anesthesiology & Surgical ICU, DUHS, Mission Rd, New Labour Colony Nanakwara, Karachi, Karachi City 74200, Pakistan.
  • Humera Ismail Department of Anesthesiology, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan.
  • Vijai Kumar Department of Anesthesiology, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan.
  • Samita S. Khan Department of Anesthesiology, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan.
  • Sidra Javed Department of Anesthesiology, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan.
DOI: https://doi.org/10.35975/apic.v25i5.1625
Keywords: Tetanus, Outcome, Survival, Intensive Care Unit, Tracheostomy, Ventilator–associated pneumonia, VAP

Abstract

Back ground & Objective: Tetanus is a preventable disease that is still prevalent in the developing countries due to inadequate vaccination practices. It has a prolonged disease course and requires an extended intensive care unit (ICU) stay, as supportive care is the mainstay for a better outcome. This study examines the clinical profile of adult tetanus patients and the impact of early tracheostomy on the final outcome in patients admitted to our ICU.

Methodology: In this retrospective observational study, patients with age of 18 y or above, diagnosed as a case of tetanus on the basis of the presence of at least two of the clinical features; trismus with or without risus sardonicus, and the rigidity of the abdominal wall and reflex spasm, were included. Neonates, pregnant and epileptic patients were excluded. The study was conducted at the ICU of our institute after approval from the Ethical Review Committee (ERC No.000003/SMBBIT/Approval/2019–2020). Medical records from August 2017 to February 2021 were collected in a pre–defined questionnaire. The primary outcome was the impact of early tracheostomy on survival and secondary outcomes were the risk factors of mortality.

Results: 48 patients were included in the study with 44 (91.7%) males and 4 (8.3%) females. The median age of patients was 25.5 (22–35) y. Lower limb was the primary site in 32 (66.7%) of the patients. Neck rigidity (39.6%) and trismus (35.4%) were the main presenting symptoms. The median incubation period was 14 (10–16) days. The median length of stay in the ICU was 28 (25–30) days. The most common complication was ventilator–associated pneumonia (VAP) acquired by 16 (33.3%) patients. Almost all patients showed a significantly higher level of creatine phosphokinase (CPK) 3908.85 ± 2974.91 IU/L, which gradually decreased on discharge to 430.48 ± 360.7 IU/L. 43 patients underwent tracheostomy. Early tracheostomy (within 7 days) was associated with a lower incidence of VAP (p = 0.000) and lesser need of mechanical ventilation (MV) (p = 0.000) with better survival rate (p = 0.000). The overall survival rate was 81.3%.

Conclusion: We conclude that the patients who underwent early tracheostomy, had better survival and lower risk of being mechanically ventilated and development of ventilator associated pneumonia. Periodic estimation of CPK level can be used as a valuable prognostic tool and predictor of mortality in tetanus patients. Age, any comorbid, mechanical ventilation and complications were the probable risk factors. Over all we had a good rate of survival.

Abbreviations: ICU – Intensive care unit; VAP – Ventilator–associated pneumonia; CPK – Creatine phosphokinase; EPI – Expanded Program of Immunization; TT – Tetanus toxoid

Key words: Tetanus; Outcome; Survival; Intensive Care Unit; Tracheostomy; Ventilator–associated pneumonia; VAP

Citation: Naz A, Rasheed G, Rao ZA, Urooj S, Ismail H, Kumar V, Khan SS, Javed S. Clinical profile of adult tetanus patients and the impact of early tracheostomy on the outcome; a retrospective observational study. Anaesth. pain intensive care 2021;25 (5):625-632; DOI: 10.35975/apic.v25i5.1625

Published
09-30-2021
How to Cite
Naz, A., Rasheed, G., Rao, Z., Urooj, S., Ismail, H., Kumar, V., Khan, S., & Javed, S. (2021). Clinical profile of adult tetanus patients and the impact of early tracheostomy on the outcome; a retrospective observational study. Anaesthesia, Pain & Intensive Care, 25(5), 625-632. https://doi.org/10.35975/apic.v25i5.1625
Issue
Vol 25 No 5 (2021): September-October
Section
ORIGINAL RESEARCH