title: Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile and risk factors for mortality.
abstract: BACKGROUND
  Tetanus, an acute infectious disease, is highly prevalent worldwide, especially in developing countries. Due to respiratory failure and hemodynamic instability associated with dysautonomia, severe cases require intensive care, but little has been published regarding the management in the Intensive Care Unit.
  
  
  OBJECTIVE
  To draw a 10-year clinical-epidemiological profile of Intensive Care Unit patients with severe tetanus, observe their evolution in the Intensive Care Unit and identify risk factors for mortality.
  
  
  METHODS
  In this retrospective study, we used a standardized questionnaire to collect information from the records of patients with severe tetanus admitted to the intensive care unit of a referral hospital for infectious and contagious diseases in Northeastern Brazil.
  
  
  RESULTS
  The initial sample included 144 patients, of whom 29 were excluded due to incomplete information, leaving a cohort of 115 subjects. The average age was 49.6±15.3 years, most patients had no (or incomplete) vaccination against tetanus, and most were male. The main intensive care-related complications were pneumonia (84.8%) and dysautonomia (69.7%). Mortality (44.5%) was higher than expected from the mean APACHE II score (11.8), with shock/multiple organ failure as the main cause of death (72.9%). The independent factors most predictive of mortality were APACHE II score, dysautonomia, continuous neuromuscular blockade and age.
  
  
  CONCLUSIONS
  A high mortality rate was observed in our cohort of Intensive Care Unit patients with severe tetanus and a number of risk factors for mortality were identified. Our results provide important insights for the development of intervention protocols capable of reducing complications and mortality in this patient population.
authors.affiliation: Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil. Electronic address: marcnob2000@yahoo.com.br.
authors.forename: Marcus Vinícius Dantas da
authors.initials: MV
authors.lastname: Nóbrega
authors.affiliation: Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil.
authors.forename: Ricardo Coelho
authors.initials: RC
authors.lastname: Reis
authors.affiliation: Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil.
authors.forename: Isabel Cristina Veras
authors.initials: IC
authors.lastname: Aguiar
authors.affiliation: Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil.
authors.forename: Timóteo Vasconcelos
authors.initials: TV
authors.lastname: Queiroz
authors.affiliation: Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil.
authors.forename: Ana Claudia Feitosa
authors.initials: AC
authors.lastname: Lima
authors.affiliation: Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil.
authors.forename: Eanes Delgado Barros
authors.initials: ED
authors.lastname: Pereira
authors.affiliation: Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil.
authors.forename: Raquel Feijó de Araújo
authors.initials: RF
authors.lastname: Ferreira
mesh_terms: D000208:Acute Disease; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013742:Tetanus / Q000209:etiology / Q000401:mortality*; D013997:Time Factors
keywords: Clinical–epidemiological tetanus; Intensive care unit; Severe accidental tetanus; Tetanus in intensive care unit