Complications of care in a medical intensive care unit.
OBJECTIVE
To determine the frequency and nature of complications of care in the medical intensive care unit (MICU).


METHODS
Prospective, observational study.


METHODS
Seven-bed MICU in a teaching and referral VA hospital.


METHODS
295 consecutive patients admitted to the MICU during a ten-month study period.


METHODS
None.


RESULTS
Forty-two patients (14%, 95% confidence interval 13%, 16%) experienced one or more complications during their MICU stays. Compared with other MICU patients, those experiencing complications tended to be older (mean age +/- SD: 63.6 +/- 10.1 years vs 59.3 +/- 14.0 years, p less than 0.02) and more acutely ill (mean Acute Physiology Score +/- SD: 18.3 +/- 8.0 vs 12.5 +/- 8.0, p = 0.0001). These patients also had significantly longer MICU lengths of stay (mean +/- SD: 12.3 +/- 14.7 days vs 3.1 +/- 4 days, p less than 0.0001) and higher hospital mortality rates (67% vs 27%, p less than 0.001). The 67% mortality rate among patients with complications significantly exceeded the expected mortality rate of 46% (calculated from the APACHE risk equation).


CONCLUSIONS
Complications of care in the MICU are not rare and may independently contribute to in-hospital mortality. The potential for complications must be recognized when considering ICU care.
Rubins
H B
HB
Department of Medicine, Boston VA Medical Center, MA 02130.
Moskowitz
M A
MA
D001900:Boston / Q000453:epidemiology; D002404:Catheterization / Q000009:adverse effects; D003422:Critical Care; D003428:Cross Infection / Q000209:etiology; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006746:Hospital Bed Capacity, 500 and over; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D013921:Thrombocytopenia / Q000139:chemically induced; D014552:Urinary Tract Infections / Q000453:epidemiology
D006493:Heparin