Back to Search
Start Over
Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus
- Source :
- Tropical Medicine and Health, Vol 49, Iss 1, Pp 1-9 (2021), Tropical Medicine and Health
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Background Tetanus remains common in many low- and middle-income countries, but as critical care services improve, mortality from tetanus is improving. Nevertheless, patients develop severe syndromes associated with autonomic nervous system disturbance (ANSD) and the requirement for mechanical ventilation (MV). Understanding factors associated with worse outcome in such settings is important to direct interventions. In this study, we investigate risk factors for disease severity and long-term physical outcome in adults with tetanus admitted to a Vietnamese intensive care unit. Methods Clinical and demographic variables were collected prospectively from 180 adults with tetanus. Physical function component scores (PCS), calculated from Short Form Health Survey (SF-36), were assessed in 79 patients at hospital discharge, 3 and 6 months post discharge. Results Age, temperature, heart rate, lower peripheral oxygen saturation (SpO2) and shorter time from first symptom to admission were associated with MV (OR 1.03 [ 95% confidence interval (CI) 1.00, 1.05], p = 0.04; OR 2.10 [95% CI 1.03, 4.60], p = 0.04; OR 1.04 [ 95% CI 1.01, 1.07], p = 0.02); OR 0.80 [95% CI 0.66, 0.94], p = 0.02 and OR 0.65 [95% CI 0.52, 0.79, p Heart rate, SpO2 and time from first symptom to admission were associated with ANSD (OR 1.03 [95% CI 1.01, 1.06], p p = 0.04 and OR 0.64 [95% CI 0.48, 0.80], p Median [interquartile range] PCS at hospital discharge, 3 and 6 months were 32.37 [24.95–41.57, 53.0 [41.6–56.3] and 54.8 [51.6–57.3], respectively. Age, female sex, admission systolic blood pressure, admission SpO2, MV, ANSD, midazolam requirement, hospital-acquired infection, pressure ulcer and duration of ICU and hospital stay were associated with reduced 0.25 quantile PCS at 6 months after hospital discharge. Conclusions MV and ANSD may be suitable endpoints for future research. Risk factors for reduced physical function at 3 months and 6 months post discharge suggest that modifiable features during hospital management are important determinants of long-term outcome.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
medicine.medical_treatment
RC955-962
030106 microbiology
Severity
law.invention
03 medical and health sciences
0302 clinical medicine
Interquartile range
law
Clostridium tetani
Arctic medicine. Tropical medicine
Internal medicine
Heart rate
medicine
Low-income and middle-income countries (LMICs)
030212 general & internal medicine
Mechanical ventilation
Tetanus
Acute critical illness
business.industry
Research
Public Health, Environmental and Occupational Health
medicine.disease
Long-term outcome
Intensive care unit
Confidence interval
3. Good health
Tetanus toxin
Infectious Diseases
Blood pressure
Vietnam
Physical function
Midazolam
business
medicine.drug
Subjects
Details
- ISSN :
- 13494147
- Volume :
- 49
- Database :
- OpenAIRE
- Journal :
- Tropical Medicine and Health
- Accession number :
- edsair.doi.dedup.....8131cacdd9f268de73e72b28cf6c11cf