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

Objectives: To establish a preliminary list of critical incidents (CIs) associated with mechanical ventilation and to describe a CI reporting method. Design: 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. Setting: The clinical observations were conducted in two intensive care units. Patients: All patients receiving mechanical ventilation were included. Measurements and results: 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. Conclusions: 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.