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. 2021 Jun 21;49(1):50.
doi: 10.1186/s41182-021-00336-w.

Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus

Rachel Davies-Foote #  1 , Truong Ngoc Trung #  2 , Nguyen Van Thanh Duoc #  2 , Du Hong Duc  3 , Phung Tran Huy Nhat  3   4 , Vo Thi Nhu Trang  5 , Nguyen Thi Kim Anh  2 , Pham Thi Lieu  3 , Duong Bich Thuy  2 , Nguyen Thanh Phong  2 , Nguyen Thanh Truong  2 , Pham Ba Thanh  2 , Dong Thi Hoai Tam  3   6 , Tran Thi Diem Thuy  2 , Pham Thi Tuyen  2 , Thanh Tran Tan  3 , James Campbell  3   7 , Le Van Tan  3 , Zudin Puthucheary  8   9 , Lam Minh Yen  3 , Nguyen Van Hao  2   6 , C Louise Thwaites  10   11
Affiliations

Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus

Rachel Davies-Foote et al. Trop Med Health. .

Abstract

Background: Tetanus remains common in many low- and middle-income countries, but as critical care services improve, mortality from tetanus is improving. Nevertheless, patients develop severe syndromes associated with autonomic nervous system disturbance (ANSD) and the requirement for mechanical ventilation (MV). Understanding factors associated with worse outcome in such settings is important to direct interventions. 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.

Methods: Clinical and demographic variables were collected prospectively from 180 adults with tetanus. 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.

Results: Age, temperature, heart rate, lower peripheral oxygen saturation (SpO2) and shorter time from first symptom to admission were associated with MV (OR 1.03 [ 95% confidence interval (CI) 1.00, 1.05], p = 0.04; OR 2.10 [95% CI 1.03, 4.60], p = 0.04; OR 1.04 [ 95% CI 1.01, 1.07], p = 0.02); OR 0.80 [95% CI 0.66, 0.94], p = 0.02 and OR 0.65 [95% CI 0.52, 0.79, p < 0.001, respectively). Heart rate, SpO2 and time from first symptom to admission were associated with ANSD (OR 1.03 [95% CI 1.01, 1.06], p < 0.01; OR 0.95 [95% CI 0.9, 1.00], p = 0.04 and OR 0.64 [95% CI 0.48, 0.80], p < 0.01, respectively). Median [interquartile range] PCS at hospital discharge, 3 and 6 months were 32.37 [24.95-41.57, 53.0 [41.6-56.3] and 54.8 [51.6-57.3], respectively. Age, female sex, admission systolic blood pressure, admission SpO2, 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.

Conclusions: MV and ANSD may be suitable endpoints for future research. 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.

Keywords: Acute critical illness; Clostridium tetani; Long-term outcome; Low-income and middle-income countries (LMICs); Physical function; Severity; Tetanus; Tetanus toxin; Vietnam.

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Conflict of interest statement

The authors declare that they have no competing interests.

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