Safety incidents in airway and mechanical ventilation in Spanish ICUs: The IVeMVA study

J Crit Care. 2018 Oct;47:238-244. doi: 10.1016/j.jcrc.2018.07.012. Epub 2018 Jul 17.

Abstract

Purpose: To assess incidence, related factors and characteristics of safety incidents associated with the whole process of airway management and mechanical ventilation (MV) in Spanish ICUs.

Materials and methods: Observational, prospective, 7 days cross-sectional multicenter study. Airway and MV related incidents were reported using structured questionnaire. Type, characteristics, severity, avoidability and contributing factors of the incidents were assessed.

Results: Participant ICUs: 104. Inclusion of 1267 patients; 745 (59%) suffered one or more incidents. Incidents reported: 2492 (59% non-harm-events, 41% adverse events). Individual risk of suffering at least one incident: 66.6%. Incidence ratio (median) of incidents: 2 per 100 patient-hours. 73.7% of incidents were related to MV process, 9.5% to tracheostomy, 6.2% to non-invasive MV, 5.4% to weaning/extubation, 4.4% to intubation and 0.8% to prone position. Temporary damage was produced in 12% incidents, while 0.8% was related to permanent injuries, risk to the patient's life or contributed to death. Incidents were considered avoidable in 73.5% of cases. 98% of all incidents had 1 or more contributing factors.

Conclusions: MV is a risk process in critical patients. Although most incidents did not harm patients, some caused damage and a few were related to the patient's death or permanent damage. Preventability is high.

Keywords: Adverse events; Incident reporting and analysis; Intensive care unit; Mechanical ventilation; Patient safety.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Female
  • Humans
  • Iatrogenic Disease / epidemiology*
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Middle Aged
  • Prospective Studies
  • Respiration, Artificial / adverse effects*
  • Spain / epidemiology
  • Tracheostomy / adverse effects*