Hostname: page-component-7b9c58cd5d-sk4tg Total loading time: 0 Render date: 2025-03-15T10:56:14.248Z Has data issue: false hasContentIssue false
  • English
  • Français

Tetanus and its complications: intensive care and management experience in 150 Indian patients

Published online by Cambridge University Press:  19 October 2009

F. E. Udwadia ,
A. Lall ,
Z. F. Udwadia ,
M. Sekhar  and
A. Vora
F. E. Udwadia
Affiliation:
The Tetanus Ward, Sir J. J. Group of Teaching Hospitals, Bombay, India
A. Lall
Affiliation:
The Tetanus Ward, Sir J. J. Group of Teaching Hospitals, Bombay, India
Z. F. Udwadia
Affiliation:
The Tetanus Ward, Sir J. J. Group of Teaching Hospitals, Bombay, India
M. Sekhar
Affiliation:
The Tetanus Ward, Sir J. J. Group of Teaching Hospitals, Bombay, India
A. Vora
Affiliation:
The Tetanus Ward, Sir J. J. Group of Teaching Hospitals, Bombay, India
Rights & Permissions [Opens in a new window]

Summary

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

A total of 150 patients were treated for tetanus in the tetanus ward of the J. J. Hospital, Bombay, between October 1983 and January 1986. The complications of tetanus and the mode of management in the presence of restricted resources are outlined. Intensive care, proper nutrition, early tracheostomy and ventilator support in severe tetanus were chiefly responsible for an overall reduction in mortality from 30 to 12%. The mortality in severe tetanus was reduced from 70 to 23%.

Sudden death due to unexpected cardiac arrest was an important complication in severe tetanus. We observed that an abrupt marked rise in rectal temperature ( > 107 °F, 41·7 °C), if undetected, could lead to sudden circulatory collapse and death. Well-marked hypoxaemia was observed in all patients with severe tetanus, and was related to ventilation perfusion inequalities and to an increase in the true venous admixture (increased Qs/Qt)in the lungs. Bronchopulmonary infections and the adult respiratory distress syndrome added significantly to morbidity and mortality. Autonomic cardiovascular disturbances included bradycardia alternating with tachycardia, and hypertension which was either labile, paroxysmal or sustained. Persistent hypotension was of ominous significance. Amongst numerous complications involving other systems, sepsis and septic shock were associated with a high mortality.

Type
Research Article
Information
Epidemiology & Infection , Volume 99 , Issue 3 , December 1987 , pp. 675 - 684
Copyright
Copyright © Cambridge University Press 1987

References

REFERENCES

Ablett, J. J. L. (1967). In Symposium on Tetanus in Great Britain, Leeds United Hospitals, (ed. Ellis, M.).Google Scholar
Benedict, C. R. & Kerr, J. H. (1977). Assessment of sympathetic overactivity in tetanus. British Medical Journal ii, 806.CrossRefGoogle Scholar
Clifton, B. (1964). Hypotension associated with tetanus. Lancet i, 785–788.CrossRefGoogle Scholar
Corbett, J. L. (1969). Cardiovascular disturbances in severe tetanus due to overactivity of the sympathetic nervous system. Anaesthesia 24, 198–203.CrossRefGoogle ScholarPubMed
Edmondson, R. S.& Flowers, M. W. (1979). Intensive care in tetanus management. Complications and mortality in 100 patients. British Medical Journal i, 1401–1404.CrossRefGoogle Scholar
Hollow, V. M.& Clarke, G. M. (1975). Autonomic manifestations of tetanus. Anaesthesia and Intensive Care 3, 142–146.CrossRefGoogle ScholarPubMed
Kanarek, D. J. (1973). Severe sympathetic hyperactivity associated with tetanus. Archives of Internal Medicine 132, 602–604.CrossRefGoogle ScholarPubMed
Kerr, J. H., Corbett, J. L., Prys-Roberts, C., Crampton Smith, A.Spaldino, J. M. K. (1968). Involvement of the sympathetic nervous system in tetanus. Studies on 82 cases. Lancet ii, 236–241.CrossRefGoogle Scholar
Kerr, J. H., Corbett, J. L.& Spaldino, J. M. K. (1969). Sympathetic overactivity in severe tetanus. Proceedings of the Royal Society of Medicine 62, 659–662.CrossRefGoogle ScholarPubMed
Kokal, K. C., Dastur, F. D., Mahashur, A. A.& Kolhatkar, U. P. (1984). Disordered pulmonary function in tetanus. Journal of the Association of Physicians of India 32, 691–695.Google ScholarPubMed
Lavesquel, P. R.& Rosenberg, H. (1975). Rapid bedside estimation of wasted ventilation. Anesthesiology 42, 98–100.CrossRefGoogle Scholar
Nicholson, D. (1976). Tetanus – still a therapeutic challenge. Heart Lung 5, 226–229.Google ScholarPubMed
Trujillo, M. M., Castillo, M. D., Espana, J. V., Guevara, M. D.& Eoanez, M. D. (1980). Tetanus in the adult: intensive care and management experience with 233 cases. Critical Care Medicine 7, 419–423.CrossRefGoogle Scholar
Tsueda, K., Oliver, P. B.& Riciiffer, R. W. (1974). Cardiovascular manifestations of tetanus. Anesthesiology 40, 588–592.CrossRefGoogle ScholarPubMed