Severe-grade tetanus in a multipurpose ICU: review of 13 cases

BACKGROUND: The mortality of severe tetanus (grades II-III) remains high today, being greater than 20% with a large number of complications, due to the lengthy stay of these patients in the ICU. METHODS: A review of 13 cases of severe tetanus over the last 5 years was performed analyzing age, entrance, previous immunization, ICU stay, grade of severity, complications and mortality. RESULTS: The ages ranged between 35 to 79 years (mean 54 years). No patient had been previously immunized. Entrance was determined in 11 patients (84.6%). The mean ICU stay was 27.3 days. Complications were presented in 76.8% of the patients, with the most frequent being vegetative alterations (38%). The global mortality was 30.7% (4 patient), 3 secondary to sepsis of pulmonary origin and one from a cardiac arrest of vegetative etiology. CONCLUSIONS: The authors believe that prophylaxis is fundamental in prevention of the disease but an important sector of the population remains unvaccinated. On appearance of severe tetanus, admission to the ICU is essential since many complications may appear requiring specialized techniques and personnel.