Service de Réanimation Médicale, Université François Rabelais, Hôpital Bretonneau, CHRU, 37044, Tours Cedex 9, France.
Intensive Care Med. 2010 Jun;36(6):1033-7. doi: 10.1007/s00134-010-1793-9. Epub 2010 Mar 9.
OBJECTIVE: To determine the incidence, risk factors, severity, and preventability of iatrogenic events (IEs) as a cause of intensive care unit (ICU) admission. DESIGN: Comparison of patients admitted or not for IE. IE was diagnosed after assessing independently predefined criteria. SETTING: The ICU of a teaching hospital. PATIENTS: All patients consecutively admitted over 6 months. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Characteristics of patients, supportive treatments, length of stay, and outcomes were recorded. For patients admitted for IE, cause, origin, and preventability of IE were assessed by consensus. Of 528 patients, 103 (19.5%) were admitted for IE. Their Simplified Acute Physiology Score (SAPS) II was higher (41.2 +/- 22.6 versus 31.4 +/- 18.6), as was their Logistic Organ Dysfunction (LOD) score. Surgical admissions and admission for shock were more frequent. The main risk factors were age, underlying disease, low Mac Cabe or Knaus score, number of physicians treating the patient, number of drugs prescribed, and other hospitalization within 1 month. Length of stay was higher (11.1 days versus 7.9 days, 0.5-6.0, p = 0.02). Catecholamine drugs, blood transfusion, and parenteral nutrition were more frequently required in the IE group. ICU mortality was 15.5% in the IE group and 11.3% in the group without IEs [not significant (ns) after adjustment]. IE was considered as probably preventable in 73.8% of cases. CONCLUSION: Of admissions to the ICU, 19.5% resulted from IE, with high proportion of shock, leading to greater need for invasive treatments and longer stay in the ICU. Most cases of IE seemed preventable.
目的:确定医源性事件(IE)作为入住重症监护病房(ICU)的原因的发生率、危险因素、严重程度和可预防性。
设计:比较因 IE 而入院和未因 IE 而入院的患者。IE 是在独立评估预先确定的标准后诊断的。
地点:一家教学医院的 ICU。
患者:连续入住 6 个月以上的所有患者。
干预措施:无。
测量和结果:记录患者的特征、支持性治疗、住院时间和结局。对于因 IE 而入院的患者,通过共识评估 IE 的原因、来源和可预防性。在 528 名患者中,有 103 名(19.5%)因 IE 而入院。他们的简化急性生理学评分(SAPS)II 更高(41.2 +/- 22.6 与 31.4 +/- 18.6),逻辑器官功能障碍(LOD)评分也更高。手术入院和休克入院更为常见。主要危险因素为年龄、基础疾病、低 Mac Cabe 或 Knaus 评分、治疗患者的医师人数、开处的药物数量以及 1 个月内的其他住院治疗。住院时间更长(11.1 天与 7.9 天,0.5-6.0,p = 0.02)。在 IE 组中,更常需要使用儿茶酚胺药物、输血和肠外营养。IE 组 ICU 死亡率为 15.5%,无 IE 组为 11.3%[调整后无统计学意义(ns)]。在 73.8%的病例中,IE 被认为是可能可预防的。
结论:在入住 ICU 的患者中,19.5%是由 IE 引起的,其中休克比例较高,导致需要更多的侵入性治疗和更长的 ICU 住院时间。大多数 IE 病例似乎是可以预防的。
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