Supportive Care for Severe Tetanus in the Intensive Care Unit: A Narrative Review
DOI:
https://doi.org/10.24843/v0ftgb42Keywords:
Tetanus, Intensive Care Units, Supportive Care, Mechanical Ventilation, SedationAbstract
Tetanus is an acute infectious disease caused by Clostridium tetani and remains associated with high mortality, particularly in severe cases requiring intensive care unit (ICU) admission. The neurotoxin tetanospasmin induces persistent muscle spasms, autonomic dysfunction, and respiratory failure, rendering ICU management complex and resource-intensive. This narrative review aims to synthesize current evidence on multimodal supportive care strategies that improve clinical outcomes in patients with severe tetanus managed in the ICU. This literature review identifies several interrelated components as central to successful management, including early airway control and mechanical ventilation, optimized sedation and spasm control using benzodiazepines, magnesium sulfate, and selected adjuvant agents, targeted nutritional and metabolic support through early enteral feeding, prevention of ICU-related complications, and early rehabilitation to mitigate ICU-acquired weakness. Collectively, evidence indicates that a comprehensive, evidence-based supportive care approach improves hemodynamic stability, reduces complication rates, and facilitates functional recovery in patients with severe tetanus.
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References
1. Yen LM, Thwaites CL. Tetanus. Lancet. 2019;393(10181):1657–1668. doi:10.1016/S0140-6736(18)33131-3
2. Karnad DR, Gupta V. Intensive care management of severe tetanus. Indian J Crit Care Med. 2021;25(suppl 2):S155. doi:10.5005/JP-JOURNALS-10071-23829
3. Karna P, Thakur AK. Tetanus: a lethal and neglected infectious disease. Ann Med Surg. 2025;87(7):4567–4569. doi:10.1097/MS9.0000000000003407
4. Sudarshan R, Sayo AR, Renner DR, et al. Tetanus: recognition and management. Lancet Infect Dis. 2025;25(11):e645–e657. doi:10.1016/S1473-3099(25)00292-0
5. Yamamoto T, Sada RM, Yamamoto S, Osawa R, Hosokawa N, Kutsuna S. Functional prognosis of older adults with tetanus in Japan: a single-center retrospective study. BMC Infect Dis. 2025;25(1):1433. doi:10.1186/s12879-025-11877-4
6. Almas T, Niaz MA, Zaidi SMJ, et al. The spectrum of clinical characteristics and complications of tetanus: a retrospective cross-sectional study from a developing nation. Cureus. 2021;13(6):e15484. doi:10.7759/cureus.15484
7. Utami IN, Arifin, Susilo RSB, Redhono D, Sumandjar T. Respiratory failure in tetanic patient: maintenance of airway problem in intensive care unit setting. IOP Conf Ser Earth Environ Sci. 2018;125(1):012153. doi:10.1088/1755-1315/125/1/012153
8. Goubrial D, Roman C, Ashok A, Mitra B. Tetanus management in a high-resource emergency department: a case report. Clin Case Rep. 2024;12(7):e9073. doi:10.1002/ccr3.9073
9. Davies-Foote R, Trung TN, Duoc NVT, et al. Risk factors associated with mechanical ventilation, autonomic nervous dysfunction, and physical outcome in Vietnamese adults with tetanus. Trop Med Health. 2021;49(1):50. doi:10.1186/s41182-021-00336-w
10. Fafolahan AO, Sodipo OP, Adeoye KK, et al. The role of physiotherapy in recovery from generalized tetanus: two case reports. Egypt Pediatr Assoc Gaz. 2023;71(1):23. doi:10.1186/s43054-023-00169-8
11. Seki M, Sugiyama M, Maeda T, Kasai F. Challenges in rehabilitation of a tetanus patient with severe complications. Cureus. 2024;16(12):e76494. doi:10.7759/cureus.76494
12. Boer M, de Voogd M, Niemeijer ND, van Hoeven L. Tetanus: a case report highlighting the challenges in diagnosis and treatment. Trop Dis Travel Med Vaccines. 2024;10(1):10. doi:10.1186/s40794-024-00220-5
13. Lipman J. Tetanus. In: Bersten AD, Handy JM, eds. Oh’s Intensive Care Manual. 8th ed. Elsevier; 2019:692–696.
14. Laksamana Jaya H, Aditya R. Pengelolaan pasien tetanus di intensive care unit. Anesth Crit Care. 2018;36(3).
15. Burgos R, Bretón I, Cereda E, et al. ESPEN guideline on clinical nutrition in neurology. Clin Nutr. 2018;37(1):354–396. doi:10.1016/j.clnu.2017.09.003
16. Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2022;43(6):687–713. doi:10.1017/ice.2022.88
17. Onwuzo C, Olukorode J, Sange W, et al. A review of the preventive strategies for venous thromboembolism in hospitalized patients. Cureus. 2023;15(11):e48421. doi:10.7759/cureus.48421
18. Mervis JS, Phillips TJ. Pressure ulcers: prevention and management. J Am Acad Dermatol. 2019;81(4):893–902. doi:10.1016/j.jaad.2018.12.068
19. Karnad DR. Tetanus. In: Kellerman RD, Rakel DP, eds. Conn’s Current Therapy. Elsevier; 2021:660–663.
20. Seo SW, Lee J, Yoo BG, Kim J, Huh SY. Autonomic instability in severe tetanus: a case report. Ann Clin Neurophysiol. 2021;23(2):117–120. doi:10.14253/ACN.2021.23.2.117
21. Duong HTH, Tadesse GA, Nhat PTH, et al. Heart rate variability as an indicator of autonomic nervous system disturbance in tetanus. Am J Trop Med Hyg. 2019;102(2):403–407. doi:10.4269/AJTMH.19-0720
22. Suyasa IK, Ryalino C, Pradnyani NPN. Dexmedetomidine Provides Better Hemodynamic Stability Compared To Clonidine In Spine Surgery. Bali Journal of Aneshtesiology. 2018;2(3):90-94. doi:10.15562/bjoa.v2i3.100
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Copyright (c) 2026 Michael Jaya, I Putu Fajar Narakusuma, Cynthia Dewi Sinardja (Author)

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