Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical care

Pandharipande, Pratik P.; Banerjee, Arna; McGrane, Stuart; Ely, E. Wesley

doi:10.1186/cc8999

Cited by 171 publications

(95 citation statements)

References 20 publications

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“…13,[31][32] Because these medications themselves contribute to worsening clinical outcomes, an evidence-based organizational approach referred to as the ABCDE bundle (Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility and exercise) has recently been suggested. 72,73 The goal of this approach is to liberate critically ill adults from the harmful effects of exposure to sedatives by using targetbased sedation protocols, spontaneous awakening trials, and proper choice of sedatives. 73 An additional goal is early mobilization, 73 which will hopefully reduce delirium and improve neurocognitive outcomes.…”

Section: Pharmacological Methodsmentioning

confidence: 99%

Management of Delirium in Critically Ill Older Adults

Balas

Rice

Chaperon

et al. 2012

Critical Care Nurse

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Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complicated because patients are often voiceless, extremely ill, and require high levels of sedatives to facilitate mechanical ventilation. An aggressive, appropriate, and compassionate management strategy may reduce the suffering and adverse outcomes associated with delirium and improve relationships between nurses, patients, and patients’ family members.

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Section: Pharmacological Methodsmentioning

confidence: 99%

Management of Delirium in Critically Ill Older Adults

Balas

Rice

Chaperon

et al. 2012

Critical Care Nurse

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“…[25,[27][28][29] This comprises of: Awakening (using light or minimal sedation); Breathing (spontaneous breathing trials); Coordination of care and communication among various disciplines; Delirium monitoring, assessment, and management; Early ambulation in the ICU.…”

Section: Prevention and Management (The Abcde Bundle)mentioning

confidence: 99%

Post-intensive care syndrome: An overview

Rawal

Yadav

Kumar

2017

Journal of Translational Internal Medicine

453

330

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Survival of critically unwell patients has improved in the last decade due to advances in critical care medicine. Some of these survivors develop cognitive, psychiatric and /or physical disability after treatment in intensive care unit (ICU), which is now recognized as post intensive care syndrome (PICS). Given the limited awareness about PICS in the medical faculty this aspect is often overlooked which may lead to reduced quality of life and cause a lot of suffering of these patients and their families. Efforts should be directed towards preventing PICS by minimizing sedation and early mobilization during ICU.All critical care survivors should be evaluated for PICS and those having signs and symptoms of it should be managed by a multidisciplinary team which includes critical care physician, neuro-psychiatrist, physiotherapist and respiratory therapist,with the use of pharmacological and non-apharmacological interventions. This can be achieved through an organizational change and improvement, knowing the high rate of incidence of PICS and its adverse effects on the survivor's life and daily activities and its effect on the survivor's family.

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“…The finding that hospital volume is also associated with report of higher level ICU activity in Washington hospitals likely results in part from larger hospitals implementing higher quality sedation order sets, as mobility use is often linked to levels of sedation (16,19,30). Care bundles that have linked sedation and mobility, such as the "ABCDE" bundle proposed by Ely and colleagues, may result in greater adoption of mobility as an intervention (31)(32)(33).…”

Section: Original Researchmentioning

confidence: 99%

Hospital-Level Factors Associated with Report of Physical Activity in Patients on Mechanical Ventilation across Washington State

Jolley

Dale²,

Hough

2015

Annals ATS

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Rationale: Use of physical and/or occupational therapy in the intensive care unit (ICU) is safe, feasible, and demonstrates improvements in functional status with early administration. Access to physical and/or occupational therapy in the ICU is variable, with little known regarding its use in community ICUs.Objectives: Determine what proportion of hospitals across Washington State report use of physical activity in mechanically ventilated patients and investigate process of care factors associated with reported activity delivery.Methods: Cross-sectional telephone interview survey study of nurse managers in hospitals caring for patients on mechanical ventilation across Washington State in 2013. Survey responses were linked with hospital-level data available in the Washington State Department of Health Comprehensive Hospital Abstract Reporting System database. Chi-square testing was used to explore unadjusted associations between potential process of care factors and report on activity delivery. Two multivariable logistic regression models were developed to explore the association between presence of a mobility protocol and report on delivery of activity. Measurements and Main Results:We identified 54 hospitals caring for patients on mechanical ventilation; 47 participated in the survey (response rate, 85.5%). Nurse managers from 36 (76.6%) hospitals reported use of physical activity in patients on mechanical ventilation, with 22 (46.8%) reporting use of high-level physical activity (transferring to chair, standing or ambulating) and 24 (51.1%) reporting use in high-severity patients (patients requiring mechanical ventilation and/or vasopressors). Presence of a written ICU activity protocol (odds ratio [OR], 5.54; 95% confidence interval [CI], 1.60-19.18; P = 0.006), hospital volume (OR, 5.33; 95% CI, 1.54-18.48; P = 0.008), and academic affiliation (OR, 4.40; 95% CI, 1.23-15.63; P = 0.02) were associated with report of higher level activity. Presence of a written ICU activity protocol (OR, 6.00; 95% CI, 1.69-21.14; P = 0.005) and academic affiliation (OR, 4.50; 95% CI, 1.21-16.46; P = 0.02) were associated with report of delivery of physical activity to high-severity patients.Conclusions: Nurse managers at three-fourths (76.6%) of eligible hospitals across Washington State reported use of physical activity in patients on mechanical ventilation. Hospital-level factors including hospital volume, academic affiliation, and presence of a mobility protocol were associated with report of higher level activity and delivery of activity to high-severity patients.Keywords: early mobilization; critical illness myopathy; physical therapy; intensive care unit-acquired weakness

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Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical care

Cited by 171 publications

References 20 publications

Management of Delirium in Critically Ill Older Adults

Management of Delirium in Critically Ill Older Adults

Post-intensive care syndrome: An overview

Hospital-Level Factors Associated with Report of Physical Activity in Patients on Mechanical Ventilation across Washington State

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