Iatrogenic complications in the ICU: prospective study during 17 months

Introduction

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

Objectives

To evaluate the incidence and types of IC in 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 June 2003. All episodes of IC are recorded. The type, the cause and the repercussions are noted. IC was divided, according to their consequences, into categories: major, moderate and minor.

Results

Two hundred and forty-three patients are enrolled with mean age 45 ± 19 years, sex ratio = 1.8, SAPS II = 34 ± 18, LOD = 6.5 ± 3.75, OMEGA score = 126 ± 228. Fifty-four per cent needed mechanical ventilation. Two hundred and fifty episodes of IC occurred in 91 patients. Incidence was 37.5% and a density of incidence of 231/1000-day stay in the ICU. Cardiovascular complications are the most frequent ones, including mainly hypotension and arrhythmia (40.8%). The incidence was judged major in 67 cases. Risk factors retained are age under 60 years, prognosis indices (SAPS II, APACHE II) and length of stay. The mortality is 45% in the event of IC and 28.75% without this.

Discussion

IC are frequent, they are induced by the development of invasive techniques of investigation and monitoring, human error 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.