Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus.

Autor: Davies-Foote R; London School of Hygiene and 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., Duc DH; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Nhat PTH; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Kings College, London, UK., Trang VTN; Gia Dinh Hospital, Da Nang 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 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; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam., Thuy TTD; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Tuyen PT; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam., Tan TT; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Campbell J; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK., Le Van Tan; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Puthucheary Z; William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.; Royal London Hospital, London, UK., Yen LM; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam., Van Hao N; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.; University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam., Thwaites CL; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. lthwaites@oucru.org.; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. lthwaites@oucru.org.
Jazyk: angličtina
Zdroj: Tropical medicine and health [Trop Med Health] 2021 Jun 21; Vol. 49 (1), pp. 50. Date of Electronic Publication: 2021 Jun 21.
DOI: 10.1186/s41182-021-00336-w
Abstrakt: Background: Tetanus remains common in many low- and middle-income countries, but as critical care services improve, mortality from tetanus is improving. Nevertheless, patients develop severe syndromes associated with autonomic nervous system disturbance (ANSD) and the requirement for mechanical ventilation (MV). Understanding factors associated with worse outcome in such settings is important to direct interventions. In this study, we investigate risk factors for disease severity and long-term physical outcome in adults with tetanus admitted to a Vietnamese intensive care unit.
Methods: Clinical and demographic variables were collected prospectively from 180 adults with tetanus. Physical function component scores (PCS), calculated from Short Form Health Survey (SF-36), were assessed in 79 patients at hospital discharge, 3 and 6 months post discharge.
Results: Age, temperature, heart rate, lower peripheral oxygen saturation (SpO 2 ) and shorter time from first symptom to admission were associated with MV (OR 1.03 [ 95% confidence interval (CI) 1.00, 1.05], p = 0.04; OR 2.10 [95% CI 1.03, 4.60], p = 0.04; OR 1.04 [ 95% CI 1.01, 1.07], p = 0.02); OR 0.80 [95% CI 0.66, 0.94], p = 0.02 and OR 0.65 [95% CI 0.52, 0.79, p < 0.001, respectively). Heart rate, SpO 2 and time from first symptom to admission were associated with ANSD (OR 1.03 [95% CI 1.01, 1.06], p < 0.01; OR 0.95 [95% CI 0.9, 1.00], p = 0.04 and OR 0.64 [95% CI 0.48, 0.80], p < 0.01, respectively). Median [interquartile range] PCS at hospital discharge, 3 and 6 months were 32.37 [24.95-41.57, 53.0 [41.6-56.3] and 54.8 [51.6-57.3], respectively. Age, female sex, admission systolic blood pressure, admission SpO 2 , MV, ANSD, midazolam requirement, hospital-acquired infection, pressure ulcer and duration of ICU and hospital stay were associated with reduced 0.25 quantile PCS at 6 months after hospital discharge.
Conclusions: MV and ANSD may be suitable endpoints for future research. Risk factors for reduced physical function at 3 months and 6 months post discharge suggest that modifiable features during hospital management are important determinants of long-term outcome.
Databáze: MEDLINE
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