Résumé
To impress on the usefulness of an organised and established protocol of management of severe tetanus in the Intensive Care Units (ICU's) of both Harare Central and Parirenyatwa Hospitals; hospital records of 244 patients treated for tetanus in these hospitals from 1980-1991 inclusively were reviewed. These included neonatal tetanus; only to highlight the seriousness of the condition at community level. The review has revealed that morbidity is still high; possibly because the local community; especialy the Black Zimbabweans has not appreciated the gravity of the disease and therefore the need for prophylaxis against tetanus. Lack of established policy for admission fo these patients to ICU has contributed to the high mortality rate especially among those patients who did not get ICU admission. Out of 159 non-neonatal cases only 72 (45.2) were trated in ICU's while the remaining 87 were left on the wards on conservative management which was not standard and ; of course; lacked in the special nursing care that ICU's provide. This has resulted in a consistenly high mortality rate in patients treated. Over the same period the ICU management has resulted in an impressive steady decline in the mortality from 50 in the beginning to 14.4 in recent years. This has been attributed to the adopted policy of standard management protocol for every patient in both ICU's and the accrued knowledgement of management of the syndrome of sympathetic nervous system overactivity over the years. Of great contricution also is the training of special ICU nurses that should provide an opportunity of having an ICU trained nurse for each patient around the clock. We have not achieved this; but this is the goal. The establishement of the M.Med (Anaestesia degree course in 1986 is deemed as significant contribution in the decline in mortality since it made it possible to have a full time cover of the ICU by a doctor. In this way complications are detected early enough and emergencies are attended to promptly. It is therefore concluded that to ensure a high survival rate in patients with severe tetanus; the treatment must be performed according to a standard protocol in an ICU