Événements iatrogènes et ventilation mécanique

The frequency and severity of iatrogenic risks are greatest in critically ill patients who require aggressive investigation and treatments. Invasive mechanical ventilation may account for one-fifth of all iatrogenic complications in Intensive Care Units. At least one-third of iatrogenic complications are preventable and most are due to human error. Critical incident (CI) reporting is well described in the literature on anesthesia and intensive care. This is used to collect and analyze incidents in which a person has acted in a way that has played a decisive role in the success or failure of that person's task. Reporting tools appropriate for the ICU are needed for comparisons of activity, development of clinical guidelines and provision of high quality training. This may be useful for unraveling proximal causes, thus enabling the development of preventive strategies. The critical incident reporting system could be adapted to the ICU environment by focusing on routine voluntary reporting of all incidents by the ICU caregivers. A list of mechanical ventilation related incident could be established by a panel of expert. A observational study conducted in ICU's with a variety of recruitment patterns would perhaps identify markers (specific CI's) or MV monitoring criteria suitable for routine continuous use as part of a quality insurance program.