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


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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.HighlightsThe whole process of mechanical ventilation (MV) and airway management is full of risk moments. The IVeMVA study explores the safety incidents in 104 Spanish ICUs related to this process. Main results:Incidence rate of 2 safety incidents per 100 patients and hour of mechanical ventilation or airway isolation.59% of incidents were non-harm-events, but almost 1% endangered the live, left severe sequelae or were related to death.Most events were reported during MV period, followed by tracheotomy, NIMV, weaning/extubation, intubation and prone position.The most dangerous moments to suffer harmful incidents to the patient were intubation, prone maneuvers and weaning.A high percentage (73%) of incidents was considered avoidable.

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