The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and meta-analysis

Sosnowski, Kellie; Lin, Frances; Chaboyer, Wendy; Ranse, Kristen; Heffernan, Aaron; Mitchell, Marion

doi:10.1016/j.ijnurstu.2022.104410

Cited by 24 publications

(14 citation statements)

References 49 publications

(279 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The bundle aims to focus on the symptoms rather than the disease process to target postintensive care syndrome (Pun et al, 2019). Implementing the ABCDEF bundle benefits patients without regard to ventilation status in the ICU (Sosnowski et al, 2023). Critically ill patients managed with the ABCDEF bundle required 3 fewer days with breathing assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care (Balas et al, 2014).…”

Section: Methodsmentioning

confidence: 99%

Postintensive Care Syndrome: Feasibly Bridging Care at a Tertiary Trauma Center

Stevens

Lee

2023

Journal of Trauma Nursing

View full text Add to dashboard Cite

Background: Advancements in critical care management have improved mortality rates of trauma patients; however, research has identified physical and psychological impairments that remain with patients for an extended time. Cognitive impairments, anxiety, stress, depression, and weakness in the postintensive care phase are an impetus for trauma centers to examine their ability to improve patient outcomes. Objective: This article describes one center's efforts to intervene to address postintensive care syndrome in trauma patients. METHODS: This article describes implementing aspects of the Society of Critical Care Medicine's liberation bundle to address postintensive care syndrome in trauma patients. Results: The implementation of the liberation bundle initiatives was successful and well received by trauma staff, patients, and families. It requires strong multidisciplinary commitment and adequate staffing. Continued focus and retraining are requirements in the face of staff turnover and shortages, which are real-world barriers. Conclusions: Implementation of the liberation bundle was feasible. Although the initiatives were positively received by trauma patients and their families, we identified a gap in the availability of long-term outpatient services for trauma patients after discharge from the hospital.

show abstract

Section: Methodsmentioning

confidence: 99%

Postintensive Care Syndrome: Feasibly Bridging Care at a Tertiary Trauma Center

Stevens

Lee

2023

Journal of Trauma Nursing

View full text Add to dashboard Cite

show abstract

“…No randomized control trials (RCTs) of treatment for withdrawal from any substance have been conducted in critically ill patients. Despite high burden of pain, delirium, and the relevance of sedation management in critically ill patients with SUDs and withdrawal, many studies on these topics have excluded patients with SUDs À explicitly and indirectly (e.g., requiring surrogate consent in patients less likely to have surrogates) [36,63,64]. This is analogous to exclusion of older adults from delirium treatment studies.…”

Section: Substance Withdrawal Pain Delirium and Preventing Overdosementioning

confidence: 99%

“…Multidisciplinary Addiction Consult Services have emerged as the gold standard approach to addressing SUDs in hospitals − providing evidence-based life-saving medications [27], reducing patient-directed discharge [28,29], increasing posthospital SUD treatment engagement [30,31], improving posthospitalization SUD severity (including abstinence from at least one substance in 40% of patients) [8,30], reducing readmissions [28,32 ▪ ,33], and preventing death [34]. The scope and magnitude of these improved outcomes appears to dwarf the effects of, for example, ‘bundles of care’ interventions in ICUs [35,36]. These treatment successes have dispelled the frequent but false notion that severe addiction in hospitalized patients is untreatable.…”

Section: Standards Of Hospital Care For Patients With Substance Use D...mentioning

confidence: 99%

Critical care for patients with substance use disorders

Steel,

Bhatraju,

Hills-Dunlap

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of review To examine the impact of substance use disorders (SUDs) on critical illness and the role of critical care providers in treating SUDs. We discuss emerging evidence supporting hospital-based addiction treatment and highlight the clinical and research innovations needed to elevate the standards of care for patients with SUDs in the intensive care unit (ICU) amidst staggering individual and public health consequences. Recent findings Despite the rapid increase of SUDs in recent years, with growing implications for critical care, dedicated studies focused on ICU patients with SUDs remain scant. Available data demonstrate SUDs are major risk factors for the development and severity of critical illness and are associated with poor outcomes. ICU patients with SUDs experience mutually reinforcing effects of substance withdrawal and pain, which amplify risks and consequences of delirium, and complicate management of comorbid conditions. Hospital-based addiction treatment can dramatically improve the health outcomes of hospitalized patients with SUDs and should begin in the ICU. Summary SUDs have a significant impact on critical illness and post-ICU outcomes. High-quality cohort and treatment studies designed specifically for ICU patients with SUDs are needed to define best practices and improve health outcomes in this vulnerable population.

show abstract

“…The 2018 MIND‐USA study, conducted at the same site, as well as 15 other institutions in the United States, reported an incidence of 48% in a similar high‐risk patient population 6 . While specific pharmacologic prophylaxis or treatment strategies have been lacking in terms of reproducible efficacy, this decrease in incidence is likely due to the improved multi‐dimensional care provided in ICUs today, such as the A‐to‐F Bundle (found at http://www.icudelirium.org), thus highlighting the importance of adopting and ensuring ongoing compliance with evidence‐based, best‐practice treatments in critically ill patients 7,8 . This decline in delirium incidence has likely halted or slowed since the coronavirus disease 2019 (COVID‐19) pandemic 9 .…”

Section: Introductionmentioning

confidence: 99%

“…6 While specific pharmacologic prophylaxis or treatment strategies have been lacking in terms of reproducible efficacy, this decrease in incidence is likely due to the improved multi-dimensional care provided in ICUs today, such as the A-to-F Bundle (found at www.icude lirium.org), thus highlighting the importance of adopting and ensuring ongoing compliance with evidence-based, best-practice treatments in critically ill patients. 7,8 This decline in delirium incidence has likely halted or slowed since the coronavirus disease 2019 (COVID-19) pandemic. 9 The change is multifactorial and has been associated with an increase in factors such as prolonged time on a ventilator and deeper levels of sedation, greater exposure to deliriogenic medication, lack of adherence to daily awakening trials, decreased mobility, and isolation-especially from a patient's family, due to onerous visitation policies.…”

Section: Introductionmentioning

confidence: 99%

Precision‐based approaches to delirium in critical illness: A narrative review

2023

View full text Add to dashboard Cite

Delirium occurs in critical illness and is associated with poor clinical outcomes, having a longstanding impact on survivors. Understanding the complexity of delirium in critical illness and its deleterious outcome has expanded since early reports. Delirium is a culmination of predisposing and precipitating risk factors that result in a transition to delirium. Known risks range from advanced age, frailty, medication exposure or withdrawal, sedation depth, and sepsis. Because of its multifactorial nature, different clinical phenotypes, and potential neurobiological causes, a precise approach to reducing delirium in critical illness requires a broad understanding of its complexity. Refinement in the categorization of delirium subtypes or phenotypes (i.e., psychomotor classifications) requires attention. Recent advances in the association of clinical phenotypes with clinical outcomes expand our understanding and highlight potentially modifiable targets. Several delirium biomarkers in critical care have been examined, with disrupted functional connectivity being precise in detecting delirium. Recent advances reinforce delirium as an acute, and partially modifiable, brain dysfunction, and place emphasis on the importance of mechanistic pathways including cholinergic activity and glucose metabolism. Pharmacologic agents have been assessed in randomized controlled prevention and treatment trials, with a disappointing lack of efficacy. Antipsychotics remain widely used after “negative” trials, yet may have a role in specific subtypes. However, antipsychotics do not appear to improve clinical outcomes. Alpha‐2 agonists perhaps hold greater potential for current use and future investigation. The role of thiamine appears promising, yet requires evidence. Looking forward, clinical pharmacists should prioritize the mitigation of predisposing and precipitating risk factors as able. Future research is needed within individual delirium psychomotor subtypes and clinical phenotypes to identify modifiable targets that hold the potential to improve not only delirium duration and severity, but long‐term outcomes including cognitive impairment.

show abstract

The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and meta-analysis

Cited by 24 publications

References 49 publications

Postintensive Care Syndrome: Feasibly Bridging Care at a Tertiary Trauma Center

Postintensive Care Syndrome: Feasibly Bridging Care at a Tertiary Trauma Center

Critical care for patients with substance use disorders

Precision‐based approaches to delirium in critical illness: A narrative review

Contact Info

Product

Resources

About