Implementation of the ABCDEF Bundle for Critically Ill ICU Patients During the COVID-19 Pandemic: A Multi-National 1-Day Point Prevalence Study

Liu, Keibun; Nakamura, Kensuke; Katsukawa, Hajime; Nydahl, Peter; Ely, E. Wesley; Kudchadkar, Sapna R.; Takahashi, Kunihiko; Elhadi, Muhammed; Gurjar, Mohan; Leong, Be Kim; Chung, Chi Ryang; Jayachandran, Balachandran; Inoue, Shigeaki; Lefor, Alan Kawarai; Nishida, Osamu

doi:10.3389/fmed.2021.735860

Cited by 30 publications

(26 citation statements)

References 44 publications

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“…This was a secondary analysis of the worldwide one-day point prevalence study performed on 27 January, 2021. 12 The ethics committee of Saiseikai Utsunomiya Hospital approved the study, which was registered in the University Hospital Medical Information Network (UMINID: 000040405).…”

Section: Methodsmentioning

confidence: 99%

“…Full details of the study methods on the point prevalence day are described in the initial publication. 12 Briefly, all ICUs in the world were eligible without any exclusion criteria. The study was performed based on the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan, 14 which stated that ethical approval at each participating institution was not necessary because the data contained no information that could potentially identify the participating ICUs or individual patients.…”

Section: Methodsmentioning

confidence: 99%

“… 10 , 11 Our previous studies showed that the ICU structure and policy (eg, ICU staffing and allocation of beds for COVID-19) were significantly associated with the implementation of evidence-based ICU care. 12 , 13 However, the patient-related barriers and differences in barriers between patients with and without COVID-19 infection have not been addressed.…”

Section: Introductionmentioning

confidence: 99%

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Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Liu

Nakamura

Kudchadkar

et al. 2022

J Intensive Care Med

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Background Mobilization and acute rehabilitation are essential in the intensive care unit (ICU), with substantial evidence supporting their benefits. This study aimed to characterize ICU mobilization practices during the COVID-19 pandemic for patients with and without COVID-19. Methods This was a secondary analysis of an international point prevalence study. All ICUs across the world were eligible to participate and were required to enroll all patients in each ICU on the survey date, 27 January 2021. The primary outcome was the achievement of mobilization at the level of sitting over the edge of the bed. Independent factors associated with mobilization, including COVID-19 infection, were analyzed by multivariable analysis. Results A total of 135 ICUs in 33 countries participated, for inclusion of 1229 patients. Among patients who were not receiving mechanical ventilation (MV), those with COVID-19 infection were mobilized more than those without COVID-19 (60% vs. 34%, p < 0.001). Among patients who were receiving MV, mobilization was low in both groups (7% vs. 9%, p = .56). These findings were consistent irrespective of ICU length of stay. Multivariable analysis showed that COVID-19 infection was associated with achievement of mobilization in patients without (adjusted odds ratio [aOR] = 4.48, 95% confidence interval [CI] = 2.71-7.42) and with MV (aOR = 2.13, 95% CI = 1.00-4.51). Factors that prevented mobilization were prone positioning in patients without MV and continuous use of neuromuscular blockade and sedation agents in patients with MV, whereas facilitating factors were the presence of targets/goals in both groups. Conclusion Mobilization rates for ICU patients across the globe are severely low, with the greatest immobility observed in mechanically ventilated patients. Although COVID-19 is not an independent barrier to the mobilization of patients with or without MV, this study has highlighted the current lack of mobility practice for all ICU patients during the COVID-19 pandemic. (299 words)

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Liu

Nakamura

Kudchadkar

et al. 2022

J Intensive Care Med

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“…To date, benefits from early mobilization, respiratory and physical therapy interventions have been supported in several conditions ( 17 – 21 ). Recently, a network meta-analysis (NMA), performed by Worraphan et al ( 22 ), assessed the effectiveness of currently available physiotherapy interventions in facilitating weaning from MV.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Physiotherapy Interventions on Weaning in Mechanically Ventilated Critically Ill Patients: A Systematic Review and Meta-Analysis

et al. 2022

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Mechanical ventilation (MV) is currently considered a life-saving intervention. However, growing evidence highlighted that prolonged MV significantly affects functional outcomes and length of stay. In this scenario, controversies are still open about the optimal rehabilitation strategies for improving MV duration in ICU patients. In addition, the efficacy of physiotherapy interventions in critical ill patients without positive history of chronic respiratory conditions is still debated. Therefore, this systematic review of randomized controlled trials (RCTs) with meta-analysis aimed at characterizing the efficacy of a comprehensive physiotherapy intervention in critically ill patients. PubMed, Scopus, and Web of Science databases were systematically searched up to October 22, 2021 to identify RCTs assessing acute patients mechanical ventilated in ICU setting undergoing a rehabilitative intervention. The primary outcomes were MV duration, extubation, and weaning time. The secondary outcomes were weaning successful rate, respiratory function, ICU discharge rate and length of stay. Out of 2503 records, 12 studies were included in the present work. The meta-analysis performed in 6 RCTs showed a significant improvement in terms of MV duration (overall effect size: −3.23 days; 95% CI = −5.79, −0.67, p = 0.01; Z = 2.47) in patients treated with a comprehensive physiotherapy intervention including early mobilization, positioning, airway clearance techniques, lung expansion and respiratory muscle training. The quality assessment underlined 9 studies (75%) of good quality and 3 studies of fair quality according to the PEDro scale. In conclusion, our results provided previously unavailable data about the role of comprehensive physiotherapy intervention in improving MV duration in critical ill patients without chronic respiratory conditions. Further studies are needed to better characterize the optimal combination of rehabilitation strategies enhancing the improvements in critical ill patients without chronic respiratory disorders.

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“…There is a clear clinical need for increased family communication and support during critical illness to improve evidence-based ICU care delivery [ 40 , 41 ]. However, there is a lack of evidence-based family support programs.…”

Section: Introductionmentioning

confidence: 99%

A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial)

Naef

Filipovic

Jeitziner

et al. 2022

Trials

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Background Family members of critically ill patients face considerable uncertainty and distress during their close others’ intensive care unit (ICU) stay. About 20–60% of family members experience adverse mental health outcomes post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation. Methods To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, we will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. It will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 h or longer. Families in the intervention arm will receive a family support intervention in addition to usual care. The intervention consists of specialist nurse support that is mapped to the patient pathway with follow-up care and includes psycho-educational and relationship-focused family interventions, and structured, interprofessional communication, and shared decision-making with families. Families in the control arm will receive usual care. The primary study endpoint is quality of family care, operationalized as family members’ satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members’ mental health (well-being, psychological distress) measured at admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference. Discussion This trial will examine the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and could be scaled up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being. Trial registration ClinicalTrials.gov NCT05280691. Prospectively registered on 20 February 2022.

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Implementation of the ABCDEF Bundle for Critically Ill ICU Patients During the COVID-19 Pandemic: A Multi-National 1-Day Point Prevalence Study

Cited by 30 publications

References 44 publications

Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Efficacy of Physiotherapy Interventions on Weaning in Mechanically Ventilated Critically Ill Patients: A Systematic Review and Meta-Analysis

A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial)

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