Abstract

Objective: To study the clinical profile and impact of early tracheostomy on outcome of adult tetanus patients at a public sector tertiary care intensive care unit .
Introduction: Tetanus is a vaccine preventable disease that is still prevalent in developing countries due to ineffective vaccine coverage .Prolong disease course is the major contributing factor of its morbidity which often requires extended ICU stay. Many treatment modalities have been tried but supportive ICU care is the main stay for better outcome. In our study we aim to assess the implications of early tracheostomy on patient survival along with its clinical profile and other associated complications observed during management.
Study Design: Observational retrospective study.
Methodology: Study was conducted at intensive care unit, Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT) after approval from Ethical review committee of institute ( ERC No.000003/SMBBIT/Approval/2019-2020).Manual record from August 2017 to February 2021 was collected and clinical parameters , management and patient outcomes were documented in a predefined pro forma.
Result: 48 patients were included in study with 44( 91.7%) males and 4(8.3%) females. The median age of patients 25.5[22-35] years . Lower limb was the primary site in most of the patients. Neck rigidity (39.6%) and trismus (35.4 %) were main presenting symptoms. Median incubation period was 14[10-16] days. The median length of stay in the intensive care unit was 28[25-30] days .Most common complication was ventilator associated pneumonia (VAP) acquired by 16(33.3%) patients. Almost all patients showed significantly higher level of creatinine phosphokinase (CPK) 3908.85±2974.91(mean±SD) , which gradually decreased on discharge 430.48±360.7 (mean±SD). Out of 48 patients 43 underwent tracheostomy. Early tracheostomy (within 7 days) was associated with lower incidence of Ventilator Associated Pneumonea (p value 0.000) reduced need of MV ( p value 0.000) thus better results in terms of survival ( p value 0.000) . Overall survival rate was 81.3%.
Conclusion: Most of our patients were admitted with severe disease we observed a satisfactory survival rate with early tracheostomy .Ventilator associated pneumonia (VAP) was noted to be the most frequent complication. Serial CPK levels can be a useful tool to predict the recovery and survival in these patients.

Key words: Keywords: Tetanus, Outcome, Intensive Care Unit, tracheostomy, Ventilator associated pneumonea (VAP)