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

• DOI: 10.1111/nicc.12740
• Publication Date: 2022-01-07T05:24:33Z
• Authors: María Jesús Frade...; Susana Arias‐Rivera; Ignacio Zaragoza‐...; Joan Daniel Martí; Elisabet Gallart; Alicia San José‐A...; Tamara Raquel Vel...; Eva Blazquez‐Mart...; Marta Raurell‐Tor...
• Keywords: Adult; early mobilization; Critical Care; Pain; mechanical ventilation; Respiració artificial; Cohort Studies; 03 medical and health sciences; delirium; Tractament del dolor; 0302 clinical medicine; 32 Ciencias Médicas; pain assessment; Pain treatment; Humans; Cura dels malalts; Critically ill; Unitats de cures intensives; Intensive care units; Delirium; Respiration, Artificial; 3. Good health; Intensive Care Units; Malalts en estat crític; Artificial respiration; sedation; Enfermería; Deliri; Care of the sick

Abstract Background The ABCDE bundle is a set of evidence‐based practices to systematically reduce the risks sedation, delirium, and immobility in intensive care patients. Implementing improves clinical outcome. Aims Objectives To investigate association between patient outcomes compliance with components ABC (analgosedation algorithms), D (delirium protocol), E (early mobilization protocol). Design A Spanish multicentre cohort study adult patients receiving invasive mechanical ventilation (IMV) for ≥48 h until extubation. Methods primary outcome was pain level, cooperation permit Medical Research Council Scale administration, days mobility. secondary cumulative drug dosing by IMV days. Tertiary (ICU days, bed rest ICU mortality, ICUAW) independent variables (analgosedation, early protocols) were also studied. Results Data collected from 605 80 ICUs 5214 IMV. Two‐thirds studied applied no protocols. Pain not assessed on 83.6% Patient made scale administration feasible 20.7% Delirium found 4.2% 69.9% respectively. Patients had shorter stays protocols fewer delirium ( P = 0.006 0.03, respectively). Analgosedation associated more opioid 0.02), propofol 0.001), dexmedetomidine lower benzodiazepine 0.008). Conclusions implementation rate very low our setting, but when implemented, stay, analgesia dosing, lighter sedation. Relevance practice Applying some all components, there increased light sedation use, decreased benzodiazepines, mobility, resulting stay