Iatrogenic complications in the ICU: prospective study during 10 months

Introduction

Iatrogenic complications (IC) are defined as an adverse event that occurs independently of the underlying disease. In fact, in the USA, IC are noted in 4% of hospitalised patients leading to death in 14% of cases.

Aim

To evaluate the incidence and types of IC in the ICU, their repercussions on morbidity and mortality rates and to identify the associated factors of risk.

Materials and methods

A prospective study, performed between February 2002 and November 2002. All episodes of IC are recorded. The type, the cause and the repercussions are noted. IC were divided, according to their consequences, into three categories: major, moderate and minor.

Results

One hundred and thirty-two patients were hospitalised during the period of study with mean age 45 ± 19 years, sex ratio = 1.6, SAPS II = 37 ± 18, APACHE II = 18 ± 10, MacCabe = 0.95 ± 0.89, LOD = 6.5 ± 3.75. Fifty-four per cent needed mechanical ventilation. One hundred and thirty-nine episodes of IC occurred in 59 patients. Incidence 44.7%, prevalence 42.5% and density of incidence of 101/1000 day stay in the ICU. Cardiovascular complications are the most frequent ones, including mainly hypotension and arrhythmia (54%). The incidence was judged major in 26 cases, leading to death in four cases, moderate in 60 cases and minor in 53 cases. Risk factors retained are: prognosis indices (SAPS II, APACHE II), a high or excessive nursing workload expressed by the OMEGA score, duration of mechanical ventilation and length of stay in the ICU.

Discussion

IC are frequent, they are induced by the development of invasive techniques of investigation and monitoring, human errors and a high or excessive nursing workload. Their pathogenesis is related to the acute disease and the characteristics of the ICU.

Conclusion

To decrease IC incidence, human and material resources must be optimised and the indications of invasive investigations and monitoring must be more rigorous.