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Complications of care in a medical intensive care unit
1Department of Medicine, Boston VA Medical Center, MA 02130.
Objective:
To determine the frequency and nature of complications of care in the medical intensive care unit (MICU).
Design:
Prospective, observational study.
Setting:
Seven-bed MICU in a teaching and referral VA hospital.
Patients:
295 consecutive patients admitted to the MICU during a ten-month study period.
Interventions:
None.
Measurements And Main 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).
Conclusion:
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.