The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study

Abstract

Background:The ABCDE bundle is a set of evidence-based practices to systematically reduce the risks of sedation, delirium, and immobility in intensive care patients.Implementing the bundle improves clinical outcome. Aims andObjectives: To investigate the association between patient outcomes and compliance with bundle components ABC (analgosedation algorithms), D (delirium protocol), and E (early mobilization protocol). Design: A Spanish multicentre cohort study of adult patients receiving invasive mechanical ventilation (IMV) for ≥48 h until extubation. Methods: The primary outcome was pain level, cooperation to permit Medical Research Council Scale administration, patient days of delirium, and mobility. The secondary outcome was cumulative drug dosing by IMV days. Tertiary outcomes (ICU days, IMV days, bed rest days, ICU mortality, ICUAW) and independent variables (analgosedation, delirium, early mobilization protocols) were also studied. Results: Data were collected from 605 patients in 80 ICUs and 5214 patient days with IMV. Two-thirds of the ICUs studied applied no protocols. Pain was not assessed on 83.6% of patient days. Patient cooperation made scale administration feasible on 20.7% of days. Delirium and immobility were found on 4.2% and 69.9% of days, respectively. Patients had shorter stays in ICUs with bundle protocols and fewer days of IMV in ICUs with delirium and mobilization bundle components (P = 0.006 and P = 0.03, respectively). Analgosedation protocols were associated with more opioid dosing

Post-Intensive Care Syndrome Prevalence Six Months after Critical Covid-19: Comparison between First and Second Waves

“…The ABCDEF bundle has been proposed to prevent PICS (46). The reduction in the duration of orotracheal intubation and in the use of sedative drugs is in line with these recommendations, with the expected immediate effects, such as a decrease in mortality and length of stay (13,47). Among the ABCDEF bundle, the avoidance of over-sedation and immobilization has shown an impact on PICS prevalence (12).…”

Clinical impact of rehabilitation and ICU diary on critically ill patients: A systematic review and meta‐analysis

“…Bundles consist of several interventions, such as the management of awareness and breathing, the choice of sedatives, daily delirium monitoring, early mobility, family engagement, good communication practices, and handout material provided by healthcare workers and their families 6 . This approach helps to achieve not only short ICU stays, but also high hospital survival 7,8 . Therefore, current guidelines recommend bundled approaches consisting of awakening, breathing coordination, delirium monitoring/management, early exercise/mobility, and family engagement 9 .…”

“…6 This approach helps to achieve not only short ICU stays, but also high hospital survival. 7,8 Therefore, current guidelines recommend bundled approaches consisting of awakening, breathing coordination, delirium monitoring/management, early exercise/mobility, and family engagement. 9 The beneficial effects of bundle approaches on physical and cognitive sequelae were proven by reductions in deep sedation and immobilisation.…”

Spotlight on literature reviews

“…The other papers in this issue employ a range of methodologies to address various clinically relevant topics, namely delirium in critically ill adults 10 and children 11 ; nurse–nurse 12 and nurse‐doctor collaboration 13 and teamwork 14 ; sleep quality 15,16 ; sedation and pressure injuries 17 and ABCDE bundle implementation 18 …”

“…8,9 These investigate the prevalence of depressive symptoms among intensive care nurses and the effect of enteral immunomodulatory nutrition formula on the outcomes of critically ill patients; targeted temperature management in acute liver failure and the compatibility of prolonged antibiotic infusion administration; and the use of virtual reality in intensive care units and educational interventions to reduce the use of physical restraints, respectively.The other papers in this issue employ a range of methodologies to address various clinically relevant topics, namely delirium in critically ill adults 10 and children 11 ; nurse-nurse 12 and nurse-doctor collaboration 13 and teamwork 14 ; sleep quality 15,16 ; sedation and pressure injuries 17 and ABCDE bundle implementation. 18 We hope you will enjoy this issue and gain a greater understanding of literature reviews.…”