Impact of adverse events on outcomes in intensive care unit patients.

  Orgeas MG, Timsit JF, Soufir L, Tafflet M, Adrie C, Philippart F, Zahar JR, Clec'h C, Goldran-Toledano D, Jamali S, Dumenil AS, Azoulay E, Carlet J; Outcomerea Study Group.

 Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France. Cette adresse e-mail est protégée contre les robots spammeurs. Vous devez activer le JavaScript pour la visualiser.

OBJECTIVE: To examine the association between predefined adverse events (AE)  (including nosocomial infections) and intensive care unit (ICU)  mortality, controlling for multiple adverse events in the same patient  and confounding variables. 

DESIGN: Prospective observational cohort  study of the French OUTCOMEREA multicenter database.

SETTING: Twelve  medical or surgical ICUs. 

PATIENTS: Unselected patients hospitalized  for > or = 48 hrs enrolled between 1997 and 2003. INTERVENTIONS:  None. 

MEASUREMENTS AND MAIN RESULTS: Of the 3,611 patients included,  1415 (39.2%) experienced one or more AEs and 821 (22.7%) had two or  more AEs. Mean number of AEs per patient was 2.8 (range, 1-26). Six AEs  were associated with death: primary or catheter-related bloodstream  infection (BSI) (odds ratio [OR], 2.92; 95% confidence interval [CI],  1.6-5.32), BSI from other sources (OR, 5.7; 95% CI, 2.66-12.05),  nonbacteremic pneumonia (OR, 1.69; 95% CI, 1.17-2.44), deep and  organ/space surgical site infection without BSI (OR, 3; 95% CI,  1.3-6.8), pneumothorax (OR, 3.1; 95% CI, 1.5-6.3), and gastrointestinal  bleeding (OR, 2.6; 95% CI, 1.4-4.9). The results were not changed when  the analysis was confined to patients with mechanical ventilation on  day 1, intermediate severity of illness (Simplified Acute Physiology  Score II between 35 and 55), no treatment-limitation decisions, or no  cardiac arrest in the ICU. 

CONCLUSIONS: AEs were common and often  occurred in combination in individual patients. Several AEs  independently contributed to death. Creating a safe ICU environment is  a challenging task that deserves careful attention from ICU physicians.