versão On-line ISSN 1678-4936
J. Venom. Anim. Toxins v.8 n.1 Botucatu 2002
INCIDENCE OF RISK FACTORS FOR NOSOCOMIAL PNEUMONIA AND RESPIRATORY COMPLICATIONS IN PATIENTS WITH TETANUS
THESIS: N. J. F. Cavalcante submitted this thesis for his Doctor of Philosophy degree in Infectious Diseases at the School of Medicine of the University of São Paulo, FMUSP, São Paulo, Brazil, in 2001.
Advisor: Dr. Eduardo Alexandrino Sérvulo de Medeiros
Co-advisor: Dr. Maria Laura Sandeville
ABSTRACT. From June 1998 to July 2000, 28 patients with tetanus were admitted to the Tetanus Infectious and Parasitic Diseases ICU of FMUSP, Hospital das Clínicas and evaluated in order to establish the incidence of respiratory complications, when they occurred, and their risk factors. All patients were evaluated for degree of tetanus severity using APACHE II. Epidemiological, clinical, radiological, and laboratory aspects necessary to evaluate muscular, renal, and lung lesions were studied. Murrays score was adopted for patients under invasive mechanical ventilation. Respiratory complications were seen in 17 (60.7%) patients, most commonly atelectasia (14=50%). Atelactasia was associated with higher benzodiazepinic doses (³ 5 mg/day) in the logistical regression model (OR=14.14; IC95%=1.36-146.91; p=0.027). Diaphragm paralysis was seen in 4 (14.3%) patients. There was one (3.6%) case of acute respiratory distress syndrome and pneumothorax. We were notified of 63 nosocomial infections in 20 (71.4%) patients, with 10 nosocomial pneumonia (35.7%) in 8 (28.6%) patients. In the univariate analysis, nosocomial pneumonia was associated with degree of tetanus severity, disautonomia, use of neuromuscular blocker (NMB), higher doses of benzodiazepines, and lower PaO/FiO2. In the multiple logistical regression, there was an association with dysautonomia (RR=31.67; IC95%=2.68-373.74; p=0.006). All 15 patients under invasive mechanical ventilation that were evaluated showed lower complacence and resistance measures. Mortality rate was lower than estimated by APACHE II and other specific scores for tetanus.
KEY WORDS: tetanus, pneumonia, risk factors, nosocomial infections, dysautonomia.
N. J. F. CAVALCANTE - Rua Ipeoig, 382/52, 05016-000, São Paulo, Brasil.