Effects of the ABCDE bundle on the prevention of post‐intensive care syndrome: A retrospective study

Abstract

AimTo identify the effects of each domain of the early and modified ABCDE bundle on post‐intensive care syndrome (PICS).DesignThis is a retrospective study.MethodsWe analysed the data from electronic medical records of 91 intensive care patients who received therapeutic interventions in stages, based on the early ABCDE bundle (admitted to the intensive care unit [ICU] from June – August 2013) and 94 patients who received interventions using a modified ABCDE bundle developed through continuous quality improvement activities (admitted to the ICU from June to August 2014).ResultsIn the ABC domain, the percentage of patients showing sedation levels of alertness and calmness increased significantly from 58.2% using the early ABCDE bundle to 72.4% using the modified ABCDE bundle. Coma prevalence decreased significantly from 45.1% using the early ABCDE bundle to 28.7% using the modified ABCDE bundle. In the E domain, the percentage of patients receiving early mobility interventions increased significantly from 11% using the early ABCDE bundle to 54.3% using the modified ABCDE bundle.ConclusionThe ABCDE bundle in the ICU helped prevent PICS by reducing deep sedation and immobilization among intensive care patients. To effectively use the ABCDE bundle, it is necessary for institutions to develop suitable protocols for each constituent element and to test their effectiveness.ImpactThe ABCDE bundle was a suitable tool to support evidence‐based practice in intensive care patients, including oversedation and immobilization, which is related to the prevention of PICS. Individual institutions will need to actively use the ABCDE bundle in the ICU, by developing protocols and testing their effectiveness.

Distorted Memories and Related Factors in ICU Patients

“…To this end, it may be effective to use the ABCDE bundle (Morandi et al, 2011;Vasilevskis et al, 2010) to routinely stimulate patient arousal, monitor delirium while controlling pain, and perform early mobilization. Using this bundle has been shown to increase the number of days where an individual does not experience delirium or being in a coma (Bounds et al, 2016;Hirshkowitz, 2004), and leads to PICS prevention (Lee et al, 2020). This can contribute to protecting 'factual memory' and fostering positive memories among patients.…”

Mixed‐method research protocol: Development and evaluation of a nursing intervention in patients discharged from the intensive care unit

“…The Early Psychologic Intervention (Peris et al., 2011 ) has been shown to cut the prevalence of anxiety, depression and PTSD by half. Another programme that included a complex, preventive psychological intervention (Lee et al., 2020 ) found self‐reported PTSD symptom severity did not fall at six months. Some reports have shown a favourable impact of the ICU diary in patients and families (Garrouste‐Orgeas et al., 2012 ; Knowles & Tarrier, 2009 ).…”

“…A systematic review (Schofield‐Robinson et al., 2018 ) of follow‐up services found it was unclear whether they reduced depression, cognitive or physical function, or increased work and educational attendance. The ABCDE bundle on the prevention of PICS (Lee et al., 2020 ) reduced deep sedation and immobilization. A Spanish trial found that a visit before hospital admission did not influence anxiety or depression (González‐Martín et al., 2019 ).…”

Creation of an International Interprofessional Simulation-enhanced Mechanical Ventilation Course

“…Mechanical ventilation (MV) is a necessary and critical part of life-supportive therapy for patients in the intensive care unit (ICU) but is associated with significant morbidity and mortality, related to both harm from MV itself (i.e., ventilator-induced lung injury) and the infectious, psychiatric, and neuromuscular sequelae of intubation, sedation, and immobility ( 1 – 3 ). How we manage patients on MV has significant and direct impacts on patient outcomes as well as hospital costs ( 4 – 6 ).…”

“…This is probably most clearly demonstrated in acute respiratory distress syndrome (ARDS), for which the use of lower tidal volume, pressure-limited strategies has consistently been shown to reduce patient mortality ( 5 , 7 , 8 ). Similarly, significant evidence exists supporting other best practices, including the use of lower tidal volume strategies for patients without ARDS ( 9 – 11 ), the early use of prone positioning for patients with moderate/severe ARDS ( 12 ), protocolized extubation protocols ( 13 ), and implementation of the ABCDEF bundle (assess, prevent, and manage pain; both spontaneous awakening trials and spontaneous breathing trials; choice of analgesia and sedation; delirium assessment, prevention, and management; early mobility and exercise; and family engagement and empowerment) ( 3 , 14 , 15 ), aimed at decreasing ventilator-associated pneumonia (VAP) and neuromuscular weakness.…”