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ICU patients are at risk for unintended and preventable adverse events involving airway management

About 25,000 potentially life-threatening errors occur daily in hospital intensive care units (ICUs). About 10 percent of these adverse events involve unintended and preventable incidents related to airway management, according to findings from a recent study. The study was supported in part by the Agency for Healthcare Research and Quality (HS11902) and carried out by researchers at Johns Hopkins University Schools of Medicine and Public Health.

The researchers point out that ICU managers should ensure appropriate ICU staffing to limit the impact of airway problems when they occur. They also suggest that prevention efforts should focus on critically ill infants and patients with complex medical conditions who are more vulnerable to errors in airway management.

The researchers analyzed patient factors (e.g., medical condition, communication, age, etc.) and system factors (e.g., ICU staffing, training, equipment, physical environment, etc.) associated with airway and nonairway events reported to a voluntary, anonymous, Web-based ICU Safety Reporting System (ICUSRS). They examined incidents reported by staff in 16 adult and 2 pediatric ICUs across the United States during a 12-month period ending June 30, 2003.

Overall, there were 78 airway and 763 nonairway events reported. More than half of airway events were considered preventable, and one patient death was attributed to an airway event. Physical injury, increased length of hospital stay, and family dissatisfaction occurred in at least 20 percent of airway events.

Most airway events reported in the ICUSRS during its first year were related to the patient's anatomical airway or endotracheal tube. Virtually all airway reports involved the ICU, with the event occurring within 2 hours of ICU admission in 13 percent of reports and during ongoing care in 86 percent of reports. Factors contributing to airway events included patient age less than 1 year and complexity of medical condition. Factors limiting the impact of airway events included adequate ICU staffing and use of skilled assistants.

For more information, see "A system factors analysis of airway events from the Intensive Care Unit Safety Reporting System (ICUSRS)," by Dale M. Needham, M.D., F.R.C.P.C., David A. Thompson, D.N.Sc., M.S., Christine G. Holzmueller, B.L.A., and others, in the November 2004 Critical Care Medicine 32(11), pp. 2227-2233.

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