Tetanus
Conditions
Brief summary
This is a randomised controlled trial of the incidence of nosocomial pneumonia in patients with severe tetanus admitted to the intensive care ward nursed in a supine or semi-recumbent position.
Detailed description
Background: Hospital-acquired pneumonia remains a common and important cause of morbidity and mortality in patients with severe tetanus who require a tracheostomy whether or not they are mechanically ventilated. We propose to investigate if the incidence of hospital-acquired pneumonia can be reduced by nursing tetanus patients semi-recumbent at 30o rather than supine as is the current practice. The aim of this study will be to assess the frequency of clinically suspected and microbiologically confirmed hospital acquired pneumonia in patients nursed in a semi-recumbent or supine body position. A secondary end-point will be the mortality in each group. Patients at risk of developing hospital acquired pneumonia (in hospital without developing pneumonia for more than two days) will be evaluated
Interventions
OTHERsemi-recumbent
Patient rests in a semi-recumbent body position
OTHERsupine
Patient rests in a supine position
Sponsors
Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
Oxford University Clinical Research Unit, Vietnam
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
1 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
1. Consecutive patients will be entered into the study as they are admitted to the intensive care ward with a clinical diagnosis of tetanus. 2. Informed consent will be obtained from the patient or next-of-kin before randomisation. 3. An envelope for the next study number will be opened in which patients will be randomly allocated to either semi-recumbent (300) or supine (00) body position. The randomisation will be created by a computer generated list. 4. All health care personnel will be instructed not to change the position, unless for medical requirements. 5. The correctness of the position will be checked twice daily. 6. Surveillance for clinical detection of pneumonia or other infection will be done daily. If infection is suspected relevant microbiological samples will be taken. 7. The study period will end 72 hours after the patient has left the intensive care ward, or if there is a permanent change in body position for more than 1 hour or death.
Exclusion criteria
1. Recent abdominal surgery (\<7 days) 2. Shock refractory to vasoactive drugs or volume therapy 3. Recent intensive care (\<30 days) 4. Neonates 5. Pneumonia at the time of admission to intensive care.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| assess the frequency of clinically suspected and microbiologically confirmed hospital acquired pneumonia | 72 hours | assess the frequency of clinically suspected and microbiologically confirmed hospital acquired pneumonia in patients nursed in a semi-recumbent or supine body position |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| mortality between supine or semi-recumbent body position | 72 hours | mortality in each group. Patients at risk of developing hospital acquired pneumonia (in hospital without developing pneumonia for more than two days) will be evaluated |
Outcome results
None listed