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Admission of tetanus patients to the ICU: a retrospective multicentre study
BACKGROUND: An extended course of tetanus (up to 6 weeks) requiring ICU admission and protracted mechanical ventilation (MV) may have a significant impact on short- and long-term survival. The subject is noteworthy and deserves to be discussed. METHODS: Twenty-two ICUs in France performed tetanus sc...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676569/ https://www.ncbi.nlm.nih.gov/pubmed/29116572 http://dx.doi.org/10.1186/s13613-017-0333-y |
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author | Mahieu, Rafael Reydel, Thomas Maamar, Adel Tadié, Jean-Marc Jamet, Angeline Thille, Arnaud W. Chudeau, Nicolas Huntzinger, Julien Grangé, Steven Beduneau, Gaetan Courte, Anne Ehrmann, Stephane Lemarié, Jérémie Gibot, Sébastien Darmon, Michael Guitton, Christophe Champey, Julia Schwebel, Carole Dellamonica, Jean Wipf, Thibaut Meziani, Ferhat Du Cheyron, Damien Kouatchet, Achille Lerolle, Nicolas |
author_facet | Mahieu, Rafael Reydel, Thomas Maamar, Adel Tadié, Jean-Marc Jamet, Angeline Thille, Arnaud W. Chudeau, Nicolas Huntzinger, Julien Grangé, Steven Beduneau, Gaetan Courte, Anne Ehrmann, Stephane Lemarié, Jérémie Gibot, Sébastien Darmon, Michael Guitton, Christophe Champey, Julia Schwebel, Carole Dellamonica, Jean Wipf, Thibaut Meziani, Ferhat Du Cheyron, Damien Kouatchet, Achille Lerolle, Nicolas |
author_sort | Mahieu, Rafael |
collection | PubMed |
description | BACKGROUND: An extended course of tetanus (up to 6 weeks) requiring ICU admission and protracted mechanical ventilation (MV) may have a significant impact on short- and long-term survival. The subject is noteworthy and deserves to be discussed. METHODS: Twenty-two ICUs in France performed tetanus screenings on patients admitted between January 2000 and December 2014. Retrospective data were collected from hospital databases and through the registers of the town hall of the patients. RESULTS: Seventy patients were included in 15 different ICUs. Sixty-three patients suffered from severe or very severe tetanus according to the Ablett classification. The median age was 80 years [interquartile range 73–84], and 86% of patients were women. Ninety per cent of patients (n = 63) required MV for a median of 36 days [26–46], and 66% required administration of a neuromuscular-blocking agent for 23 days [14–29]. A nosocomial infection occurred in 43 patients (61%). ICU and 1-year mortality rates were 14% (n = 10) and 16% (n = 11), respectively. Forty-five per cent of deaths occurred during the first week. Advanced age, a higher SAPS II, any infection, and the use of vasopressors were significantly associated with a lower number of days alive without ventilator support by day 90. Age was the only factor that significantly differed between deceased and survivors at 1 year (83 [81–85] vs. 79 [73–84] years, respectively; p = 0.03). Sixty-one per cent of survivors suffered no impairment to their functional status. CONCLUSION: In a high-income country, tetanus mainly occurs in healthy elderly women. Despite prolonged MV and extended ICU length of stay, we observed a low 1-year mortality rate and good long-term functional status. |
format | Online Article Text |
id | pubmed-5676569 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-56765692017-11-20 Admission of tetanus patients to the ICU: a retrospective multicentre study Mahieu, Rafael Reydel, Thomas Maamar, Adel Tadié, Jean-Marc Jamet, Angeline Thille, Arnaud W. Chudeau, Nicolas Huntzinger, Julien Grangé, Steven Beduneau, Gaetan Courte, Anne Ehrmann, Stephane Lemarié, Jérémie Gibot, Sébastien Darmon, Michael Guitton, Christophe Champey, Julia Schwebel, Carole Dellamonica, Jean Wipf, Thibaut Meziani, Ferhat Du Cheyron, Damien Kouatchet, Achille Lerolle, Nicolas Ann Intensive Care Research BACKGROUND: An extended course of tetanus (up to 6 weeks) requiring ICU admission and protracted mechanical ventilation (MV) may have a significant impact on short- and long-term survival. The subject is noteworthy and deserves to be discussed. METHODS: Twenty-two ICUs in France performed tetanus screenings on patients admitted between January 2000 and December 2014. Retrospective data were collected from hospital databases and through the registers of the town hall of the patients. RESULTS: Seventy patients were included in 15 different ICUs. Sixty-three patients suffered from severe or very severe tetanus according to the Ablett classification. The median age was 80 years [interquartile range 73–84], and 86% of patients were women. Ninety per cent of patients (n = 63) required MV for a median of 36 days [26–46], and 66% required administration of a neuromuscular-blocking agent for 23 days [14–29]. A nosocomial infection occurred in 43 patients (61%). ICU and 1-year mortality rates were 14% (n = 10) and 16% (n = 11), respectively. Forty-five per cent of deaths occurred during the first week. Advanced age, a higher SAPS II, any infection, and the use of vasopressors were significantly associated with a lower number of days alive without ventilator support by day 90. Age was the only factor that significantly differed between deceased and survivors at 1 year (83 [81–85] vs. 79 [73–84] years, respectively; p = 0.03). Sixty-one per cent of survivors suffered no impairment to their functional status. CONCLUSION: In a high-income country, tetanus mainly occurs in healthy elderly women. Despite prolonged MV and extended ICU length of stay, we observed a low 1-year mortality rate and good long-term functional status. Springer International Publishing 2017-11-07 /pmc/articles/PMC5676569/ /pubmed/29116572 http://dx.doi.org/10.1186/s13613-017-0333-y Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Research Mahieu, Rafael Reydel, Thomas Maamar, Adel Tadié, Jean-Marc Jamet, Angeline Thille, Arnaud W. Chudeau, Nicolas Huntzinger, Julien Grangé, Steven Beduneau, Gaetan Courte, Anne Ehrmann, Stephane Lemarié, Jérémie Gibot, Sébastien Darmon, Michael Guitton, Christophe Champey, Julia Schwebel, Carole Dellamonica, Jean Wipf, Thibaut Meziani, Ferhat Du Cheyron, Damien Kouatchet, Achille Lerolle, Nicolas Admission of tetanus patients to the ICU: a retrospective multicentre study |
title | Admission of tetanus patients to the ICU: a retrospective multicentre study |
title_full | Admission of tetanus patients to the ICU: a retrospective multicentre study |
title_fullStr | Admission of tetanus patients to the ICU: a retrospective multicentre study |
title_full_unstemmed | Admission of tetanus patients to the ICU: a retrospective multicentre study |
title_short | Admission of tetanus patients to the ICU: a retrospective multicentre study |
title_sort | admission of tetanus patients to the icu: a retrospective multicentre study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676569/ https://www.ncbi.nlm.nih.gov/pubmed/29116572 http://dx.doi.org/10.1186/s13613-017-0333-y |
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