Respiratory failure in tetanic patient: maintenance of airway problem in intensive care unit setting

1st International Conference on Tropical Medicine and Infectious Diseases (ICTROMI) Faculty of Medicine Universitas Sumatera Utara

Utami, I.N.^1 ; Arifin^2 ; Susilo, R.S.B.^2 ; Redhono, D.^2 ; Sumandjar, T.^2

Internal Medicine Department, Medical Faculty of Sebelas Maret, University-dr. Moewardi Hospital, Surakarta, Indonesia^1

Tropical Medicine and Infectious Disease Division, Internal Medicine Department, Medical Faculty of Sebelas, Maret University-dr. Moewardi Hospital, Surakarta, Indonesia^2

关键词: Acinetobacters;    Clostridium tetani;    Continuous injections;    Fatality rates;    Levofloxacin;    Metronidazole;    Respiratory failure;    Respiratory rate;   

Others  :  https://iopscience.iop.org/article/10.1088/1755-1315/125/1/012153/pdf
DOI  :  10.1088/1755-1315/125/1/012153

来源: IOP

【 摘 要 】

Tetanus is a toxin-mediated disease caused by Clostridium tetani resulting in muscular stiffness and painful spasm. The case fatality rates are high (10-80%), and the most frequent cause of mortality is airway problem that results in respiratory failure. A 52-year-old malecame to the hospital with lockjaw, rhesussardonicus, opisthotonus, and seizure for the last 12 hours, diagnosed with tetanus grade II. We placed the patient in an isolation room, gave 3000U tetanus immunoglobulin, 20mg diazepam in 500ml dextrose 5%/8 hours, and 500mg/6hrs metronidazole. On the seventh day, seizure became frequent, respiratory rate increased with crackles found on the auscultation, and the blood gas analysis showed respiratory failure type II (PCO253mmHg). The patientwas immediately sent to the ICU, intubated and given ventilator support. The patientwas sedated with continuous injection of midazolam 3 mg/h, morphine 10mcg/kgBW/h and also levofloxacin 750mg/24hours. Bronchoalveolar lavage culture was positive for Acinetobacter baumanii, so we changed the antibiotic to amikacin injection 500 mg/8hrs. After four days, we extubated the ventilator and transferred from HCU three days later. The patient was fully recovered and discharged after eighteen days of hospitalization.