Bevz G. Clinical picture and intensive care of patients with severe tetanus

The scientific research is devoted to clinical pathogenetical grounding of kinds and aims of measures to improve intensive care of patients with severe tetanus. We analyzed different kinds of tetanus, i.e. annual, long-term dynamics, seasonal sickness, mortality, age, sex etc. on the population of Central Ukraine. Established in 20-year period evidence (1990-2009), incidence has tended to decrease and for the past 5 years it did not exceed 0.11 cases per 100,000 of population, while mortality still exceeds 60%. There was conducted aprospective-retrospective cohort study among 157 patients with severe tetanus. It demonstrated that the most clinically significant complications of the disease are pneumonia (55.4%), bronchitis (22.9%) and myocarditis (21%). The main direct cause of death of these patients is acute respiratory failure, caused by acute obstruction of the upper respiratory tract, and in the later stages of the disease - nosocomial pneumonia. There was refined the representation of the major risk factors that affect the clinical course and poor outcome of tetanus. We demonstrated the importance of continuous administration of anti-tetanus serum throughout the convulsive period, the use of early treatment of restrictive infusion therapy, providing for the first 24 hours of treatment of upper airway protection and mechanical ventilation.