The management of tetanus in adults in an intensive care unit in Southern Vietnam

Wellcome Open Research

article

Nguyen Van Hao¹  Lam Minh Yen³  Rachel Davies-Foote⁴  Truong Ngoc Trung¹  Nguyen Van Thanh Duoc¹  Vo Thi Nhu Trang⁵  Phung Tran Huy Nhat³  Du Hong Duc³  Nguyen Thi Kim Anh¹  Pham Thi Lieu³  Tran Thi Diem Thuy¹  Duong Bich Thuy¹  Nguyen Thanh Phong¹  Nguyen Thanh Truong¹  Pham Ba Thanh¹  Dong Thi Hoai Tam¹  Zudin Puthucheary⁶  C Louise Thwaites³ 

[1] Hospital for Tropical Diseases;University of Medicine and Pharmacy;Oxford University Clinical Research Unit;London School of Hygiene & Tropical Medicine;Gia Dinh Hospital;William Harvey Research Institute, Queen Mary, University of London;Royal London Hospital;Centre for Tropical Medicine and Global Health, University of Oxford

关键词: Tetanus;    management;    treatment;    low middle income country;    LMIC;    intensive care unit;    ICU;   

DOI  :  10.12688/wellcomeopenres.16731.2

学科分类：内科医学

来源: Wellcome

【 摘 要 】

Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere.Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria.Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days.  Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients.Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common.

【 授权许可】

CC BY