Implementation of the “awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility” bundle in the pediatric intensive care unit of tertiary hospitals in southwestern China: a cross-sectional survey

Abstract

Objective To investigate management and implementation of the “awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility” (ABCDE) bundle in the pediatric intensive care unit (PICU) in southwestern China Methods A self-designed questionnaire for determining implementation of the ABCDE bundle was distributed to healthcare professionals in the PICU. Multiple linear regression was used to analyze results. Results A total of 270 questionnaires were collected. There was no significant difference in the awareness of the ABCDE bundle rate among Sichuan, Guizhou, and Yunnan workers. Only dynamic adjustment of drug dose accounted for more than half (55.5%) of “frequent implementation” and “general implementation”, followed by implementation of sedation assessment, pain assessment, and spontaneous breathing trials (46.4%, 39.3%, and 35.6%, respectively). A total of 80.4% of healthcare professionals never performed screening of delirium. Multivariate analysis showed that the healthcare professionals’ scores of ABCDE bundle behavior significantly differed regarding awareness of the ABCDE bundle, years of work at the hospital, the region of hospitals, and occupational category. Conclusion Implementation of the ABCDE bundle in the PICU in southwestern China is not sufficient. Existing problems need to be identified and a standardized sedation and analgesia management model needs to be established.

ABCDEF Bundle Practices for Critically Ill Children: An International Survey of 161 PICUs in 18 Countries*

“…Delirium is highly prevalent in critically ill children with validated tools for screening (7, 8, 39, 40). Although delirium screening has increased since 2013 thanks to heightened attention in the adult literature and validation of more pediatric-specific tools (7, 8, 39, 40), screening occurs in only 20–40% of the surveyed PICUs in this study, this is in line with other surveys (25–29%) (5, 41, 42). Screening is the first major step in delirium prevention and treatment using both nonpharmacologic and, when indicated, pharmacologic approaches (43).…”

“…Similar barriers have been acknowledged regarding delirium screening or early mobilization in the PICU (47)(48)(49). In fact, a recent survey of clinicians in Chinese PICUs revealed that about half of the respondents were not aware of the ABCDE bundle strategy (42).…”

“…Similar barriers have been acknowledged regarding delirium screening or early mobilization in the PICU (47–49). In fact, a recent survey of clinicians in Chinese PICUs revealed that about half of the respondents were not aware of the ABCDE bundle strategy (42). Interprofessional PICU teams can use these domains and related barriers as a guide to develop and select tailored implementation strategies that take into consideration their own PICU’s specific context and barriers.…”

Rol de enfermería frente al delirium en unidad de cuidado intensivo pediátrico: Scoping Review

“…Otra función de los profesionales de enfermería es la educación al personal frente al DP, pues cuando los profesionales desconocen este síndrome, pueden llegar a confundirlo con otras entidades clínicas lo cual deriva en un diagnóstico o tratamiento ausente o inadecuado y a su vez concluye en resultados desfavorables para la salud del paciente y la calidad del cuidado 20,24,27,28 . Es necesario mejorar la educación sobre el delirium en todos los niveles de formación para mejorar su identificación y tratamiento y al mismo tiempo fortalecer la capacidad y confianza del personal frente al mismo 20 .…”

“…Algunos autores promueven la implementación del paquete ABCDEF 27,28 , es un paquete de intervenciones para liberar a pacientes de soporte vital que incluye el manejo de delirium 29 . Esta estrategia ha sido utilizada en adultos, sin embargo, la encuesta de Huang et al sobre la implementación del paquete ABCDE en UCIP en el sur de China reveló que el uso de este paquete en entornos pediátricos es significativamente menor al que se presenta en unidades de cuidado intensivo de adultos y que además la mitad de los respondientes de este estudio no conocían esta estrategia 28 .…”