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

Autor: Hao NV; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.; University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam., Yen LM; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Davies-Foote R; London School of Hygiene & Tropical Medicine, London, UK., Trung TN; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Duoc NVT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Trang VTN; Gia Dinh Hospital, Danang City, Vietnam., Nhat PTH; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Duc DH; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Anh NTK; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Lieu PT; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Thuy TTD; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Thuy DB; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Phong NT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Truong NT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Thanh PB; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Tam DTH; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.; University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam., Puthucheary Z; William Harvey Research Institute, Queen Mary, University of London, London, UK.; Royal London Hospital, London, UK., Thwaites CL; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Jazyk: angličtina
Zdroj: Wellcome open research [Wellcome Open Res] 2021 Aug 31; Vol. 6, pp. 107. Date of Electronic Publication: 2021 Aug 31 (Print Publication: 2021).
DOI: 10.12688/wellcomeopenres.16731.2
Abstrakt: 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.
Competing Interests: No competing interests were disclosed.
(Copyright: © 2021 Hao NV et al.)
Databáze: MEDLINE
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