Incidentes clínicos associados à sobreutilização de dispositivos invasivos em terapia intensiva: estudo de coorte

Abstract

Introduction: The overuse of assistive technologies, such as invasive devices, has been frequently associated with increased healthcare costs, as well as an elevated risk of incidents for patients. It is estimated, based on the Choosing Wisely initiative, that nurses perform routine actions that can contribute to the judicious use of technologies in intensive care units. Overall Objective: To analyze the occurrence of clinical incidents related to the overuse (excessive duration of use) of intravascular devices, indwelling urinary catheters, and invasive mechanical ventilation, and the outcomes of hospitalization duration and mortality in intensive care units. Method: Retrospective cohort study in a single center, involving patients admitted to four intensive care units from May 1, 2022, to May 31, 2023. The primary outcome was the occurrence of clinical incidents, and upon identifying incidents, a prognostic factor impact analysis was performed regarding the length of stay (in the units and in the hospital) and mortality. Medical records of patients aged ≥18 years admitted to intensive care units who used the analyzed invasive devices were included. Data were extracted from the hospital's commercial software, Epimed Monitor System® (Epimed Solutions®, Rio de Janeiro). Statistical analysis was conducted using R version 4.3.1 and OpenEpi® version 3.01. Results: A total of 1,766 medical records were included, evaluating 5,436 devices. Devices were divided into groups: intravascular devices, mechanical ventilation (endotracheal tube and tracheostomy), and indwelling urinary catheters. Mechanical ventilation devices had the highest average duration (13.65 days). Sixty-one incidents with invasive devices were recorded, with those associated with mechanical ventilation being the most frequent. Regarding severity, 41 (77.35%) of the incidents with harm were classified as moderate. Healthcare-associated infections related to invasive devices were the most frequent incidents, accounting for 28 (45.9%) of the total. The occurrence of incidents with devices exposed patients to risks of complications, increased length of stay (p-value < 0.001), and a higher risk of death (p-value < 0.001). Conclusion: The overuse of routinely used devices in intensive care units, such as central venous catheters, invasive mechanical ventilation, and indwelling urinary catheters, increases the risk of clinical incidents, particularly healthcare-associated infections. The occurrence of incidents prolongs the length of stay and increases hospital mortality. The overuse of invasive devices is associated with a higher risk of severe clinical incidents and unfavorable outcomes (higher mortality and longer hospitalization).