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All Journal Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
I Putu Fajar Narakusuma
Udayana University
Health Professions Medicine & Pharmacology Physics

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Supportive Care for Severe Tetanus in the Intensive Care Unit: A Narrative Review Michael Jaya; I Putu Fajar Narakusuma; Cynthia Dewi Sinardja
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI APRIL
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/v0ftgb42

Abstract

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.
Supportive Care for Severe Tetanus in the Intensive Care Unit: A Narrative Review Michael Jaya; I Putu Fajar Narakusuma; Cynthia Dewi Sinardja
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 1 (2026): JATI April 2026
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/v0ftgb42

Abstract

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.
Bougie-First Versus Stylet-First Technique for Tracheal Intubation in Adults: A Systematic Review and Meta-analysis Oktavio Jalu Kuncoro Jati; I Putu Fajar Narakusuma; Gde Bagus Susila Pradnyana Nurcahyo Oka; Regina Florean Napitupulu; Jeseline Felicia Liem; Tirza Faithania Amaris; Elmer Sebastian Cruz
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 2 (2026): JATI AUGUST
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/8hqnbs41

Abstract

Introduction: Bougie-first and stylet-first techniques are widely used to facilitate adult tracheal intubation, but randomized evidence remains inconsistent across emergency, intensive care, and operating room settings. This systematic review and meta-analysis aimed to compare bougie-first versus stylet-first intubation in adults, focusing on first-attempt intubation success and key procedural and airway-related safety outcomes. Material and Methods: We conducted a PRISMA 2020–compliant systematic review registered in PROSPERO (CRD420261298317). PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched from database inception to 31 January 2026. Records were screened in duplicate, and randomized controlled trials enrolling adults (≥18 years) undergoing oral tracheal intubation comparing a planned bougie-first strategy versus a planned stylet-first strategy were included. Random-effects meta-analyses pooled dichotomous outcomes as odds ratios (ORs) and continuous outcomes as mean differences (MDs). Results: From 1,158 records, eight randomized controlled trials involving 2,578 participants were included. First-attempt intubation success did not differ significantly between bougie-first and stylet-first techniques (OR 0.99, 95% CI 0.37–2.65; p = 0.980), with substantial heterogeneity (I² = 89.05%; p < 0.001). Bougie-first was associated with longer time to successful intubation (MD 21.84 seconds, 95% CI 5.55–38.14; p = 0.010), although heterogeneity was very high (I² = 97.37%; p < 0.001). There were no significant differences in more than one attempt (OR 0.91, 95% CI 0.21–3.91; p = 0.900), esophageal intubation (OR 0.48, 95% CI 0.17–1.40; p = 0.180), pulmonary aspiration (OR 1.47, 95% CI 0.57–3.75; p = 0.420), or postoperative sore throat (OR 1.10, 95% CI 0.48–2.52; p = 0.830).  Conclusion: Current randomized evidence did not demonstrate a consistent difference in first-attempt intubation success between bougie-first and styletfirst tracheal intubation in adults. Bougie-first was associated with longer intubation time, but this finding should be interpreted cautiously because of very high heterogeneity and variable timing definitions. 
Bougie-First Versus Stylet-First Technique for Tracheal Intubation in Adults: A Systematic Review and Meta-analysis Oktavio Jalu Kuncoro Jati; I Putu Fajar Narakusuma; Gde Bagus Susila Pradnyana Nurcahyo Oka; Regina Florean Napitupulu; Jeseline Felicia Liem; Tirza Faithania Amaris; Elmer Sebastian Cruz
Jurnal Anestesiologi dan Terapi Intensif Vol. 2 No. 2 (2026): JATI AUGUST
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/8hqnbs41

Abstract

Introduction: Bougie-first and stylet-first techniques are widely used to facilitate adult tracheal intubation, but randomized evidence remains inconsistent across emergency, intensive care, and operating room settings. This systematic review and meta-analysis aimed to compare bougie-first versus stylet-first intubation in adults, focusing on first-attempt intubation success and key procedural and airway-related safety outcomes. Material and Methods: We conducted a PRISMA 2020–compliant systematic review registered in PROSPERO (CRD420261298317). PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched from database inception to 31 January 2026. Records were screened in duplicate, and randomized controlled trials enrolling adults (≥18 years) undergoing oral tracheal intubation comparing a planned bougie-first strategy versus a planned stylet-first strategy were included. Random-effects meta-analyses pooled dichotomous outcomes as odds ratios (ORs) and continuous outcomes as mean differences (MDs). Results: From 1,158 records, eight randomized controlled trials involving 2,578 participants were included. First-attempt intubation success did not differ significantly between bougie-first and stylet-first techniques (OR 0.99, 95% CI 0.37–2.65; p = 0.980), with substantial heterogeneity (I² = 89.05%; p < 0.001). Bougie-first was associated with longer time to successful intubation (MD 21.84 seconds, 95% CI 5.55–38.14; p = 0.010), although heterogeneity was very high (I² = 97.37%; p < 0.001). There were no significant differences in more than one attempt (OR 0.91, 95% CI 0.21–3.91; p = 0.900), esophageal intubation (OR 0.48, 95% CI 0.17–1.40; p = 0.180), pulmonary aspiration (OR 1.47, 95% CI 0.57–3.75; p = 0.420), or postoperative sore throat (OR 1.10, 95% CI 0.48–2.52; p = 0.830).  Conclusion: Current randomized evidence did not demonstrate a consistent difference in first-attempt intubation success between bougie-first and styletfirst tracheal intubation in adults. Bougie-first was associated with longer intubation time, but this finding should be interpreted cautiously because of very high heterogeneity and variable timing definitions. 
Co-Authors Cynthia Dewi Sinardja Elmer Sebastian Cruz Gde Bagus Susila Pradnyana Nurcahyo Oka Jeseline Felicia Liem Michael Jaya Oktavio Jalu Kuncoro Jati Regina Florean Napitupulu Tirza Faithania Amaris