Méndez CC, Madrigal CDA

Language: Spanish
References: 38
Page: 206-220
PDF size: 981.78 Kb.

ABSTRACT

Introduction: severe tetanus remains a significant challenge in intensive care units (ICUs), particularly in Latin America where gaps in vaccination and delayed diagnosis persist. Critically ill patients often present with refractory spasms, autonomic dysfunction, and respiratory compromise requiring advanced life support. Objective: to provide an updated review of the pathophysiology, severity criteria, diagnostic approach, and intensive care management of tetanus, with emphasis on targeted therapies and prevention of complications. Material and methods: a narrative review of recent literature (2010-2024) was conducted, focusing on adult patients and including clinical studies, ICU cohorts, management guidelines, and trials evaluating therapies for spasm control, autonomic instability, and organ support. Results: tetanospasmin-mediated neurotoxicity explains rigidity, spasms, and autonomic instability that frequently require mechanical ventilation and hemodynamic support. Early administration of human tetanus immunoglobulin, stepwise spasm control with benzodiazepines, and selective neuromuscular blockade form the core of management. Autonomic dysfunction requires invasive monitoring and tailored pharmacologic therapy. Common ICU complications include rhabdomyolysis, arrhythmias, ventilator-associated pneumonia, sepsis, and prolonged immobilization. Early rehabilitation is associated with improved functional outcomes. Conclusions: ICU management of tetanus should be protocolized, prioritizing rapid toxin neutralization, effective spasm suppression, and autonomic stabilization. Prevention of ICU-related complications and early rehabilitation are key to improving survival and functional recovery. Important evidence gaps persist regarding autonomic therapies, magnesium use, and standardized sedation protocols, highlighting the need for further research.

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