[Tetanus. Physiopathology and intensive care treatment].
BACKGROUND
Tetanus as a topic illness is underlined on the basis of the increased cases as well as the appearance of new populations at risk of infection. The tetanospasmins of mechanism action is stressed in order to evaluate the etiopathogenetic role of common therapies as well as the new ones. Ten cases of serious infection personally observed are analysed.


METHODS
The case records of ten tetanus patients treated in our Intensive Care Unit between 1986 and 1997 have been retrospectively analysed. The prognosis correlated to the seriousness of the case. The most common clinical symptoms on admission were trismus and dysphagia (100% of patients). In 70% of cases, the illness was considered serious enough to warrant the use of neuro-muscular blockers and controlled ventilation. Among the complications observed pulmonary problems had the highest incidence (90%), followed by cardio-vascular ones (80%). Respiratory infections were the most frequently observed (9 patients). Autonomic dysfunction was a constant feature in patients with severe forms of the illness.


RESULTS
The observed mortality rate was 30%. It was higher in males at the extremes of the age range.


CONCLUSIONS
In the light of the survival results as well as the most recent literature data, guidelines for the approach of serious tetanic patients are outline. It is underlined that therapy effectiveness is higher when from being a symptom therapy it becomes an etiopathogenetic therapy.
Romitti
M
M
Servizio di Anestesia e Rianimazione, Ospedale Civile, Piacenza.
Romitti
F
F
Banchini
E
E
D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D013742:Tetanus / Q000503:physiopathology* / Q000628:therapy*