The ABCDE Bundle Associated with Significant Reductions in Duration of Mechanical Ventilation

journals.lww.com February 1, 2020

the-awakening-and-breathing-coordination-delirium-monitoring-and-management-and-early-mobilization-bundle-abcde

The focus on long-term consequences of critical illness has intensified with increasing ICU utilization and survivorship. Post Intensive Care Syndrome (PICS) is increasingly recognized and has profound and long-lasting negative impacts on ICU survivors as well as their families and caregivers.

The exact mechanisms for the development of PICS are not quite known even though some aspects of PICS may simply be essential to critical illness and inevitable, avoiding complication practices is an essential aspect to the effective delivery of critical care.

The ABCDEF bundle is an organizational approach to screen for and treat a series of variables affecting intensive care patients in an evidence-based manner and is designed to limit iatrogenic harms and improve the care of the critically ill and consists of the following components:

A – Assess, prevent and manage pain;
B – Both spontaneous awakening trials and spontaneous breathing trials;
C – Choice of analgesia and sedation;
D – assess, prevent, and manage Delirium;
E – Early mobility and exercise; and
F – Family engagement and empowerment.

Previous work demonstrates bundle implementation improved meaningful clinical outcomes including duration of mechanical ventilation, delirium, frequency of mobilization, and survival, and higher bundle compliance is associated with incremental improvements in rates of survival, delirium, and coma, suggesting a possible dose-response effect.

Recently, the Society of Critical Care Medicine (SCCM) embarked on the ICU Liberation Collaborative, a large-scale quality improvement initiative in 76 ICUs across the United States designed to facilitate application of the Pain, Agitation, and Delirium Guidelines through ABCDEF bundle implementation. The initial findings from this initiative were published, and bundle performance was associated with improvement in many significant clinical outcomes including survival, mechanical ventilation use, coma, delirium, restraint-free care, ICU readmissions, and post-ICU discharge to facility rather than home.