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. 2017 Nov 7;7(1):112.
doi: 10.1186/s13613-017-0333-y.

Admission of tetanus patients to the ICU: a retrospective multicentre study

Rafael Mahieu  1 , Thomas Reydel  1 , Adel Maamar  2 , Jean-Marc Tadié  2 , Angeline Jamet  3 , Arnaud W Thille  3 , Nicolas Chudeau  4 , Julien Huntzinger  5 , Steven Grangé  6 , Gaetan Beduneau  6 , Anne Courte  7 , Stephane Ehrmann  8 , Jérémie Lemarié  9 , Sébastien Gibot  9 , Michael Darmon  10 , Christophe Guitton  11 , Julia Champey  12 , Carole Schwebel  12 , Jean Dellamonica  13 , Thibaut Wipf  14 , Ferhat Meziani  14 , Damien Du Cheyron  15 , Achille Kouatchet  1 , Nicolas Lerolle  16
Affiliations

Admission of tetanus patients to the ICU: a retrospective multicentre study

Rafael Mahieu et al. Ann Intensive Care. .

Abstract

Background: An extended course of tetanus (up to 6 weeks) requiring ICU admission and protracted mechanical ventilation (MV) may have a significant impact on short- and long-term survival. The subject is noteworthy and deserves to be discussed.

Methods: Twenty-two ICUs in France performed tetanus screenings on patients admitted between January 2000 and December 2014. Retrospective data were collected from hospital databases and through the registers of the town hall of the patients.

Results: Seventy patients were included in 15 different ICUs. Sixty-three patients suffered from severe or very severe tetanus according to the Ablett classification. The median age was 80 years [interquartile range 73-84], and 86% of patients were women. Ninety per cent of patients (n = 63) required MV for a median of 36 days [26-46], and 66% required administration of a neuromuscular-blocking agent for 23 days [14-29]. A nosocomial infection occurred in 43 patients (61%). ICU and 1-year mortality rates were 14% (n = 10) and 16% (n = 11), respectively. Forty-five per cent of deaths occurred during the first week. Advanced age, a higher SAPS II, any infection, and the use of vasopressors were significantly associated with a lower number of days alive without ventilator support by day 90. Age was the only factor that significantly differed between deceased and survivors at 1 year (83 [81-85] vs. 79 [73-84] years, respectively; p = 0.03). Sixty-one per cent of survivors suffered no impairment to their functional status.

Conclusion: In a high-income country, tetanus mainly occurs in healthy elderly women. Despite prolonged MV and extended ICU length of stay, we observed a low 1-year mortality rate and good long-term functional status.

Keywords: Aged; Comorbidity; Elderly patient; Intensive care unit; Mechanical; Mechanical ventilation; Outcome; Prognosis; Tetanus; Ventilators.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curve for cumulative survival.
Survival data are censored at one year. No patient was lost to follow-up at one year
See this image and copyright information in PMC

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