Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle*

Abstract

Objective The debilitating and persistent effects of intensive care unit (ICU)-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle into everyday practice. Design Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012. Setting Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center. Patients Two hundred ninety-six patients (146 pre- and 150 post-bundle implementation), age ≥ 19 years, managed by the institutions’ medical or surgical critical care service. Interventions ABCDE bundle. Measurements For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between ABCDE bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Main Results Patients in the post-implementation period spent three more days breathing without mechanical assistance than did those in the pre-implementation period (median [IQR], 24 [7 to 26] vs. 21 [0 to 25]; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the ABCDE bundle experienced a near halving of the odds of delirium (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.33–0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (OR, 2.11; 95% CI, 1.29–3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates. Conclusions Critically ill patients managed with the ABCDE bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care.

Use of Physical Restraints in Dutch Intensive Care Units: A Prospective Multicenter Study

“…All analyses were repeated for each imputed data set and subsequently combined into a single estimate according to the by AACN on May 9, 2018 http://ajcc.aacnjournals.org/ Downloaded from (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) 161 (42) 94 (25) 68 (18) 47 (12) 9 (2) 124 ( …”

Post-intensive care syndrome: An overview

“…The most important preventive strategies shown to have a positive impact in preventing the long-term functional disabilities associated with PICS include limiting the use of deep sedation and encouraging early mobility in the ICU patients, along with aggressive physical and occupational therapy. [24][25][26][27] This requires a multidisciplinary approach for the best outcome and successful management.…”

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery

“…The impact that delirium has on healthcare costs and patient outcomes has led to a number of interventions to prevent it or reduce its duration, but unfortunately the high prevalence of delirium persists despite these attempts. Many studies of therapies to prevent postoperative or ICU delirium have focused on nonpharmacologic interventions, including multicomponent care pathways, geriatrics consultation, optimization of the patient's environment, enforcing appropriate sleep hygiene, and utilization of sensory aids (14)(15)(16)(17)(18)(19). Even with multiple non-pharmacologic measures, however, delirium persists in the studied populations.…”