Background
Tetanus, a rare disease in today’s world, when occurs, takes a devastating course. However, with proper treatment and ventilatory support, patients with tetanus can survive and lead a healthy event-free life.

Aims
To describe the clinical features, course, complications, treatment and outcomes in patients admitted to the medical intensive care unit (MICU) with severe generalised tetanus requiring mechanical ventilation.

Methods
A prospective study was conducted between September 2014 to February 2016, on 40 patients who had severe generalised tetanus. Adult patients (above 12 years age) who required mechanical ventilatory support were included. A detailed history, laboratory parameters, medications, supportive medical care, duration of mechanical ventilation and outcome were studied. Outcomes were defined as complete recovery or death.

Results
This study showed male to female ratio of 3:1, with 67.5 per cent patients under the age of 40 years. Most of the patients (95 per cent) were from rural population and all patients were unimmunized. Mortality was 82.6 per cent, when period of onset was less than two days. Autonomic dysfunction was the attributed cause of death in first seven days of hospital stay, while from second week onwards death was due to secondary complications (sepsis, ventilator associated pneumonia, etc.). Overall mortality rate was 52.5 per cent.

Conclusion
Shorter the period of onset, more severe the disease, and high the mortality. Early mortality was attributed to autonomic dysfunction, while late mortality is attributed to secondary complications. These results matched with the existing literature and historical studies.