Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile and risk factors for mortality

Abstract Introduction 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. Conclusion 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.

Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile and risk factors for mortality.

INTRODUCTION: 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. CONCLUSION: 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.

Caracterização de pacientes com doenças infecciosas internados em Unidade de Terapia Intensiva / Patient characteristics with infectious diseases hospitalized in the Intensive Care Unit / Caracterización de pacientes com enfermedades infecciosas internados en Unidad de Terapia Intensiva

Objetivo: caracterizar o perfil clinicoepidemiológico dos pacientes internados em uma Unidade de Terapia Intensiva de doenças infecciosas. Método: estudo exploratório e descritivo, retrospectivo, com abordagem quantitativa, realizado em um hospital público em Fortaleza/CE, com 203 pacientes. Os dados coletados dos prontuários dos pacientes, de abril a agosto de 2015, foram analisados pela estatística descritiva a partir de tabelas e figuras. Resultados: predominou o sexo masculino (68,5%) e a faixa etária dos 21 aos 35 anos (32%), seguida da faixa dos 36 aos 50 anos (31,5%). O principal diagnóstico médico foi a aids (50,2%). A média de permanência dos pacientes na unidade foi de 11 dias e 49,8% evoluíram para óbito. Conclusão: comprovou-se predomínio do sexo masculino e da faixa etária de 21 a 35 anos, tendo como diagnóstico principal a aids. Os pacientes permaneceram na UTI em média de 11 dias e mais da metade evoluiu para o óbito.(AU)

Objective: to characterize the clinical and epidemiological profile of patients with infectious diseases admitted to an Intensive Care Unit. Method: an exploratory, descriptive, and retrospective study with a quantitative approach, performed in a public hospital in Fortaleza/CE, with 203 patients. The data collected were from medical records of patients from April to August 2015, analyzed using descriptive statistics from tables and figures. Results: males (68.5%) and the age group of 21 to 35 years (32%) predominated followed by the range of 36 to 50 years old (31.5%). The main medical diagnosis was AIDS (50.2%). The average length of stay of patients in the unit was 11 days and 49.8% died. Conclusion: proven to be predominantly male and aged 21 to 35 years old, with AIDS as the main diagnostic. The patients remained in the ICU an average of 11 days and more than half died.(AU)

Objetivo: caracterizar el perfil clínico epidemiológico de los pacientes internados en una unidad de terapia intensiva de enfermedades infecciosas. Método: estudio exploratorio y descriptivo, retrospectivo, con enfoque cuantitativo, realizado en un hospital público en Fortaleza/CE, con 203 pacientes. Los datos recogidos de los prontuarios de los pacientes, de abril a agosto de 2015, fueron analizados por la estadística descriptiva a partir de cuadros y figuras. Resultados: predominó el sexo masculino (68,5%) y la edad de 21 a 35 años (32%), seguida de 36 a 50 años (31,5%). El principal diagnóstico médico fue el SIDA (50,2%). La media de permanencia de los pacientes en la unidad fue de 11 días y 49,8% murieron. Conclusión: se comprobó predominio del sexo masculino y de la edad de 21 a 35 años, teniendo como diagnóstico principal el SIDA. Los pacientes permanecieron en el UTI en media de 11 días y más de la mitad fallecieron.(AU)

Conhecimento do enfermeiro de unidade de terapia intensiva sobre o procedimento de aspiração endotraqueal / Knowledge of intensive care unit nurses about the procedure of endotracheal suctioning

Objetivo: verificar o conhecimento dos enfermeiros acerca do procedimento de aspiração endotraqueal realizado na unidade de terapia intensiva (UTI). Metodologia: estudo exploratório descritivo, com abordagem quantitativa, realizado nas Unidades de Terapia Intensiva de um hospital público, em Fortaleza-CE, com uma amostra de 39 enfermeiros. Dados coletados de abril a maio de 2012, com um questionário, organizados no Excel e submetidos à análise estatística. Estudo aprovado pelo Comitê de Ética da instituição com parecer no. 090207/11. Resultados: quanto ao procedimento de aspiração endotraqueal, chama a atenção a não realização da ausculta pulmonar por 69,23%. Outros pontos merecem destaque como a não suspensão da dieta enteral (51,29%) e a não utilização dos Equipamentos de Proteção Individual (51,28%) durante o procedimento; 94,27% utilizam soro fisiológico 0,9% para fluidificar as secreções. Conclusão: há necessidade de intensificar as atividades educativas quanto à importância dos cuidados durante o procedimento, na tentativa de minimizar os riscos para os pacientes.

Objective: to evaluate nurses' knowledge about the procedure of endotracheal suctioning performed in the Intensive Care Unit (ICU). Method: descriptive exploratory study with a quantitative approach, carried out in the Intensive Care Unit of a public hospital in Fortaleza-CE, with 39 nurses. Data collected from April to May 2012, from a questionnaire and organized into an Excel and subjected to statistical analysis. Study approved by the Ethics Committee of Hospital with number 090207/11. Results: regarding the procedure of endotracheal suction, draws attention not to perform the lung auscultation for 69.23%. Other points that deserve attention include the non-suspension of enteral feeding (51.29%) and non-use of Personal Protective Equipment (51.28%) during the procedure; 94.27% said to use saline solution at 0.9% to thin the secretions. Conclusion: it´s need to intensify the educational activities regarding the importance of care during the procedure, in order to minimize risks to patients.

Uso da ventilaçäo näo invasiva na disfuncao diafragmatica pos-cirurgia cardiaca como tecnica de desmane: relato de caso / Noninvasive mechanical ventilation as an auxiliary method for weaning a patient with diaphragmatic dysfunction after cardiac surgery. case report

A incidência de disfunção diafragmática após cirurgia cardíaca e de aproximadamente 25 a 75 por cento.Em cerca de 10 por cento ha lesão de nervo frênico e paresia diafragmática levando a complicações como atelectasia ou pneumonia.Descrevemos um caso de disfunção diafragmática pós-cirurgia cardíaca,em decorrência do possível resfriamento do nervo frênico durante o ato cirúrgico.Enfatizamos na apresentação o uso da ventilação mecânica não invasiva através de máscara nasal ou facial como método capaz de manter a assistência ventilatória,evitando as complicações inerentes a presenca do tubo endotraqueal e proporcionando extubação precoce