Patient selection: adult (>= 18 years of age) with tetanus admitted to the ICU
The risk factor identified on multivariate analysis as predictive of nosocomial pneumonia was dysautonomy with lability in heart rate, blood pressure, diaphoresis (sweating, sudoresis) and salivation. The odds ratio was 32 making pneumonia likely if autonomic dysfunction was present.
Additional risk factors identified on univariate analysis:
(1) severe or very severe tetanus
(2) use of neuromuscular blocking agents
(3) higher dose of diazepam (>= 5 mg/kg per day)
(4) lower ratio of PaO2 to FIO2 (< 200)
where:
• The text says "lower arterial oxygen and oxygen fraction" which is interpreted as meaning the PaO2 to FIO2 ratio.
• Several of the factors relate to respiratory failure and/or need for mechanical ventilation.
• A patient with mild tetanus probably would not be in the ICU unless associated with some other form of injury.
• The severity of the tetanus is based on the scale of Bleck et al.
