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

Orgeas, Maite Garrouste MD; Timsit, Jean Francois MD, PhD; Soufir, Lilia MD; Tafflet, Muriel MSc; Adrie, Christophe MD; Philippart, Francois MD; Zahar, Jean Ralph MD; Clec’h, Christophe MD; Goldran-Toledano, Dany MD; Jamali, Samir MD; Dumenil, Anne-Sylvie MD; Azoulay, Elie MD, PhD; Carlet, Jean MD

doi: 10.1097/CCM.0b013e31817b879c
Clinical Investigations

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 ≥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.

From the Medical-Surgical ICU (MGO, FP, JC), Saint Joseph Hospital Network, Paris, France; Medical ICU (JFT), Albert Michallon Hospital, Grenoble, France; INSERM U823 Outcome of Cancer and Critical Illness Unit (JFT), Albert Bonniot Institute, La Tronche Cedex, France; Department of Anesthesiology (LS), Saint Joseph Hospital Network, Paris, France; Department of Biostatistics (MT), Outcomerea, France; Medical-Surgical ICU (CA), Delafontaine Hospital, Saint Denis, France; Department of Microbiology (JRZ), Necker Teaching Hospital, Paris, France; Medical-Surgical ICU (CC), Avicenne Teaching Hospital, Bobigny, France; Medical-Surgical ICU (DGT), Gonesse Hospital, France; Medical-Surgical ICU (SJ), Dourdan Hospital, Dourdan, France; Surgical ICU (ASD), Antoine Béclère Teaching Hospital, Clamart, France; Medical ICU (EA), Saint Louis Teaching Hospital, Paris, France.

Outcomerea is supported by nonexclusive research grants from Aventis Pharma, France and Wyeth, France and by public grants from the Centre National de la Recherche Scientifique (CNRS). The Outcomerea data warehouse is supported by a grant from the Agence Nationale de Revalorisation de la Recherche (ANVAR). These grants had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.

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The members of the OUTCOMEREA study group are listed in the appendix.

Dr. Azoulay has consulted for Pfizer, received honoraria/speaking fees form Pfizer and Gilead, and has received grant support from Pfizer. Dr. Carlet has consulted for Cerexa and received honoraria/speaking fees from Becton Dickinson, AstraZeneca, and bioMerieux. The remaining authors have not disclosed any potential conflicts of interest.

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins