The ABCDEF Bundle for the Respiratory Therapist

Abstract

The clinical approach to the critically ill patient has changed dramatically over the last several decades from one of deep sedation to that of mobilizing patients on mechanical ventilation and limiting sedation. The ABCDEF bundle is a multidisciplinary, evidence-based approach to the holistic management of critically ill patients that aims to optimize patient recovery, minimize iatrogenesis, and engage and empower the patient and family during their hospitalization. To achieve this goal, the bundle includes assessments for pain, delirium, and readiness to stop sedation and to start spontaneous breathing trials. It also encourages early mobilization of the patient, avoidance of restraints, and engagement with the family in bedside rounds to improve communication. Performance of this bundle reduces mortality, ventilator days, intensive care readmissions, delirium, coma, restraint use, and discharge to facilities in a dose-dependent manner. The respiratory therapist, as a key member of the critical care team, is essential to the implementation, performance, and success of the ABCDEF bundle. This review aims to describe each component of the ABCDEF bundle, provide evidence for both the impact of individual interventions as well as the entire bundle, and detail the importance of this multidisciplinary approach to the care of the critically ill patient.

Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis*

“…Evidences have shown that the awakening trial is necessary for sustaining cortical arousal, which promoted further recovery of the nervous system and improved functional efficiency of the brain ( 36 , 38 ). In addition, as demonstrated in previous research, passive range-of-motion activities (the “E” element) could also stimulate the brain activities that might have contributed to the decrease in the proportion of patient-days with coma ( 39 , 40 ). Further studies are necessary to verify this result.…”

Early Detection and Intervention for Patients with Delirium Admitted to the Department of Internal Medicine: Lessons from a Pilot Initiative

“…We believe that proof of effectiveness for most of the actions advocated as essential for reversing delirium [1, 7, 8, 14-16] is either no longer required or cannot be assessed unless randomization is applied. On the other hand, there is insufficient information for which medical patients presenting with delirium early M&P is most valuable.…”

“…Nevertheless, based on clinical documentation, only a third or less of delirium cases are recognized on admission [7], and delirium screening, particularly outside ICUs, requires considerable improvement. Also, a large number of prevention and management measures have been advocated and validated [14, 15], often grouped under easy-to-remember mnemonics like DELIRIUM [1] or ABCDEF [16]. Unfortunately, once a multidimensional approach has been initiated to address and treat reversible factors, there are almost no measures to improve delirium per se.…”

Medication Adherence in a Community Population with Uncontrolled Asthma

“…The PDC was only calculated for participants who had a minimum of three preventers dispensed on separate occasions in the preceding 12-month period. For the purpose of analysis, adherence was dichotomized to a PDC of 80% or greater (adherent) or a PDC of less than 80% (non-adherent) [ 46 ]. In case no instructions for medication administration appeared in the medication record or in cases where dose variability occurred, standard dosage was used to calculate the number of days covered for each medication dispensed.…”