Timing of Tracheostomy and Outcomes in Adults with Moderate and Severe Tetanus

Abstract

Objective: This study aimed to evaluate the timing of tracheostomy and relationship to outcomes (length of hospital stay, length of mechanical ventilation, morbidity and mortality rate) in adults with moderate and severe tetanus. 
 Methods: 
 Design: Cross-Sectional Study
 Setting: Tertiary Government Training Hospital
 Patients: All adult patients (19 years old and above) diagnosed with moderate and severe stage tetanus from January 2015 to January 2018 were considered for inclusion.
 Results: There were 109 patients included in this study, majority were males (n=95) with a male to female ratio of 7:1. Most belonged to the 51-60 years age group (mean: 53.7 SD: +/-16.1). Based on Cole Tetanus staging, the majority presented with severe stage tetanus (67.9%; n=74). Only 35.8% (n=39) were admitted at the Intensive Care Unit. Early tracheostomy was performed in 56.0% (n=61) of the patients (mean 6.3 hours SD: +/- 4.61). Mortality rate was noted to be 52.3% (n=57). Overall, early tracheostomy among moderate to severe stage tetanus patients showed shorter length of hospital stay and length of mechanical ventilation than late tracheostomy (tracheostomy >24 hours) (p-value < .05). However, no significant difference was noted for timing of tracheostomy in terms of morbidity and mortality rate (p-value > .05).
 Conclusion: Early tracheostomy within less than 24 hours from time of admission for moderate and severe tetanus is associated with shorter length of hospital stay and mechanical ventilation than late tracheostomy, and may play a role in tetanus management.
 Keywords: tracheostomy; tetanus; hospital stay; mechanical ventilation; morbidity; mortality

Head and Neck Symptoms as Predictors of Outcome in Tetanus Patients

“…8 A study by Espinosa and Vinco looked into the relationship between the timing of tracheostomy and outcomes of tetanus, such as length of hospital stay, length of mechanical ventilation, morbidity, and mortality rate. 12 They defined early tracheostomy as performed within 24 hours from time of admission while those performed beyond 24 hours were classified as late tracheostomy. Results of this study showed that early tracheostomy in moderate and severe stage tetanus led to shorter length of hospital stay and length of mechanical ventilation than late tracheostomy.…”

“…Results of this study showed that early tracheostomy in moderate and severe stage tetanus led to shorter length of hospital stay and length of mechanical ventilation than late tracheostomy. 12 With that in mind, early tracheostomy becomes a justifiable step in patients with moderate to severe tetanus. 8 Once tracheostomy is immediately initiated and management is early administered especially in moderate to severe cases such as Stage II and III, good prognosis, which can be manifested by decannulation, becomes more likely.…”