To identify the risk factors of mechanical ventilation implementation in adult patients with tetanus.

Total of 48 adult cases with tetanus were enrolled in Beijing Ditan Hospital, Captial Medical University from September 2008 to May 2017. The patients were divided into two groups, including 33 patients with mechanical ventilation and 15 patients without mechanical ventilation. Gender, age, onset to treatment time, incubation period, initial performance, injury site, the symptom of dysphagia, debridement in the hospital, use of tetanus antitoxin (TAT) , use of tetanus immunoglobulin (TIG), onset of convulsions,the symptom of dyspnoea and spontaneous respiratory thythm instability were analyzed, retrospectively.

The chi-square test showed that gender, age, onset to treatment time, incubation period, initial performance, injury site, the symptom of dysphagia, debridement in the hospital, use of TAT or TIG had no relationship with mechanical ventilation implementation, without significant difference (allP> 0.05). However, the symptom of dyspnoea, spontaneous respiratory thythm instability was significantly associated with mechanical ventilation implementation (χ² = 13.191,P< 0.001;χ²= 18.960,P< 0.001;χ²= 7.884,P = 0.005), with significant differences. Multivariate regression analysis of the above three factors showed that the onset of convulsions, the symptom of dyspnea, and spontaneous respiratory thythm instability were the risk factors of mechanical ventilation,OR(95%CI) were 18.109 (2.114-155.141, P= 0.008 ), 13.781 (1.822-104.26,P= 0.011) and 18.400 (1.234-274.305,P= 0.035), respectively.

If the patient with tetanus had convulsions, the symptom of dyspnea, and spontaneous respiratory thythm instability, with indicated that the patient should be mechanically ventilated.