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

• Main Authors: Rafael Mahieu, Thomas Reydel, Adel Maamar, Jean-Marc Tadié, Angeline Jamet, Arnaud W. Thille, Nicolas Chudeau, Julien Huntzinger, Steven Grangé, Gaetan Beduneau, Anne Courte, Stephane Ehrmann, Jérémie Lemarié, Sébastien Gibot, Michael Darmon, Christophe Guitton, Julia Champey, Carole Schwebel, Jean Dellamonica, Thibaut Wipf, Ferhat Meziani, Damien Du Cheyron, Achille Kouatchet, Nicolas Lerolle
• Format: Article
• Language: English
• Published: SpringerOpen 2017-11-01
• Series: Annals of Intensive Care
• Subjects: Tetanus; Intensive care unit; Outcome; Mechanical ventilation; Elderly patient; Prognosis
• Online Access: http://link.springer.com/article/10.1186/s13613-017-0333-y

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.