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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
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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

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