Critical incidents related to invasive mechanical ventilation in the ICU: preliminary descriptive study.

Abstract

To establish a preliminary list of critical incidents (CIs) associated with mechanical ventilation and to describe a CI reporting method. A list of CIs was established based on a consensus among ICU caregivers. The list was compared to CIs collected prospectively during a predefined study period. The clinical observations were conducted in two intensive care units. All patients receiving mechanical ventilation were included. The list of CIs included death and 62 other CI types categorized as immediately life-threatening, secondarily life-threatening, or non-life-threatening. The observational study identified 527 CIs in 137 patients. Virtually all non-life-threatening CIs were ascribed to failure to comply with safety rules or to equipment failure and 40% of life-threatening CIs to the course of the disease or to patient-related factors. The match between CI types on the list and CI types observed in the ICUs was excellent. Use of our reporting method to create a CI database in a multicenter study including ICUs with varying recruitment patterns may help to identify markers suitable for routine continuous use as part of a quality-assurance program.