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Iatrogenic complications in ICU patients
Critical Care volume 10, Article number: P394 (2006)
Introduction and objective
Iatrogenic complications in the ICU are inevitable and often lead to medical emergencies. They may affect the clinical course of patients by increasing morbidity and mortality. The aim of this study was to evaluate frequency, types, severity and morbidity of complications associated with medical and nursing practice, to determine possible risk factors and to suggest efficient protective measures for reducing the risk.
Patients and methods
Eighty-four adult patients were included in the study over a 12-month period. An iatrogenic complication was defined as an adverse effect that was not associated with the patients' underlying disease. Two ICU physicians who assessed all complications monitored patients during their entire hospitalization and a 6-month follow-up. Drug interactions and their adverse effects were excluded.
Ninety-nine iatrogenic complications were recorded in 42 of the 84 admissions. Although 58 (39%) complications were considered as major, none was directly associated with the death of a patient. Major complications included respiratory distress, severe hypotension, pneumothorax, hemothorax, cardiac arrest and bacteremia. Eighty-five per cent of the complications were due to human errors while misused and default material were considered the cause of the rest. Patients with a higher APACHE II score experienced more complications (25 ± 5.9, P = 0.027). The subgroup of patients admitted to the ICU with more than two organ failures had also a higher risk for an iatrogenic complication (P = 0.045). The age of the patient, excessive nursing workload as well as the number of complications were the most important prognostic factors (P = 0.022, P = 0.015, P = 0.056, respectively) for persistent morbidity. Patients without complications had a 2.89-fold higher possibility of survival compared with those with complications. Days in the ICU and APACHE II score were statistically significantly lower in these patients (P < 0.0001).
Iatrogenic complications were common and associated with increased morbidity and mortality rates. Human errors accounted for the majority of them, and were often associated with high nursing workload. The elderly and the severely ill patients are at greater risk of presenting a major complication. To increase safety, preventive measures should be taken. Better organization of the daily workload, better training of the medical and nursing staff as well as avoidance of invasive monitoring, wherever this is possible, could contribute to decrease iatrogenic complications.
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Laskou, M., Nikolaou, H., Diamantea, F. et al. Iatrogenic complications in ICU patients. Crit Care 10 (Suppl 1), P394 (2006). https://doi.org/10.1186/cc4741