Challenges of tracheostomy in patients managed for severe tetanus in a developing country.

OBJECTIVES: Severe tetanus is one of the indications for admissions into the intensive care unit requiring muscular paralysis, tracheostomy and mechanical ventilatory support. This study aimed to evaluate tetanus patients managed with tracheostomy and to determine associated complications.

METHODS: This was a 16-year review of patients who were managed for tetanus with tracheostomy in an intensive care unit between 1999 and 2009. The data collected from the medical records including demographic data, clinical presentations, tetanus immunization history, suspected portal entry of infection, duration of ICU admission, endotracheal intubation, tracheostomy, and complications.

RESULTS: Of the 31 patients studied, 11 (35.48%) were aged ≤15 years and all had history of completed childhood tetanus vaccination. Only 6 (19.35%) patients who were above 15 year-old had no history of previous childhood tetanus vaccination. None of these patients had tetanus booster shot. All patients had tracheostomy and 42% developed complications following tracheostomy.

CONCLUSIONS: Tetanus is still a major health problem in developing countries and this can be prevented if recommended childhood tetanus vaccination and booster shots regimen are properly taken. Although, tracheostomy is associated with complications in severe tetanus patients, these patients would have all died of cardio-respiratory failure if tracheostomy had not been performed.