Fatores de risco associados ao óbito em pacientes que sofreram eventos adversos internados em uma unidade de terapia intensiva

Abstract

Introduction: Patient safety is described as reducing the harm associated with health care to an acceptable minimum. Adverse events (AE) necessarily cause some harm to the patient and are related to health care. They are classified according to the degree of damage caused to the patient, namely: mild, moderate, severe and fatal. Notification is a used tool to identify and analyze any type of event, ensuring proper management of failures and errors in routines and activities. The occurrence of AE has a significant relationship with the increase in the length of stay and the mortality of patients in the ICU, implying major consequences and damage to health systems, requiring actions aimed at work processes and reduction of events. Objective: To identify risk factors associated with death in patients who suffered adverse events in an intensive care unit. Material and Methods: This is a retrospective cohort study with the collection and analysis of data from electronic medical records. Patients who had an adverse event during hospitalization in the ICU of a University Hospital in Minas Gerais, between 2019 and 2020 were included. The variables were collected: attendance; sex; age; patient's origin; date of ICU admission; CID on admission; use of mechanical ventilation; use of sedation; comorbidities; EA date; EA shift; type of EA; EA degree; date of EA notification; notification shift; notified by which specialty; length of stay after the AE; length of stay in the ICU; condition at discharge. To evaluate the association between characteristics and mortality, a Cox model was performed, with results presented as hazard ratio (HR) and respective confidence intervals (CI) of 95% raw and adjusted. Results: The total sample consisted of 335 patients, more than half of whom were male (61.2%) and 75.5% were 60 years of age or older. Regarding comorbidities, 74.6% had systemic arterial hypertension (SAH), 31.0% DM, 21.5% heart disease and 19.8% CKD. The mean number of comorbidities was 2.7 ± 1.6. The mortality rate was 34.0%. The female sex (HR 1.59, 95% CI 1.08; 2.34), increasing age (HR 1.02, 95% CI 1.01; 1.04), have hypertension (HR 1.89, 95% CI 1.20; 2.95), heart disease (HR 1.70, 95% CI 1.10; 2.62) and lung disease (HR 2.04, 95% CI 1.14; 3.67) represented a higher risk of mortality in the crude analysis. In the adjusted analysis represented by the multiple model controlled by the use of mechanical ventilation, female sex was associated with a higher risk of death (HR 1.55, 95% CI 1.05; 2.30), as well as increasing age (HR 1.019, 95% CI 1.003; 1.036) and arterial hypertension (HR 1.67, 95% CI 1.04; 2.67). Conclusion: The data found in this study identified that being female, increasing age, having hypertension, heart disease and lung disease represent a higher risk of mortality in the ICU in patients with AE