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

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dc.contributor.authorFrade Mera, María Jesús
dc.contributor.authorArias Rivera, Susana
dc.contributor.authorZaragoza García, Ignacio
dc.contributor.authorMartí, Joan Daniel
dc.contributor.authorGallart, Elisabet
dc.contributor.authorSan José Arribas, Alicia
dc.contributor.authorVelasco Sanz, Tamara Raquel
dc.contributor.authorBlazquez Martínez, Eva
dc.contributor.authorRaurell Torredá, Marta
dc.date.accessioned2023-06-22T10:40:25Z
dc.date.available2023-06-22T10:40:25Z
dc.date.issued2022-01-06
dc.descriptionCRUE-CSIC (Acuerdos Transformativos 2021)
dc.description.abstractBackground: 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 and Objectives: 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 (P = 0.02), and delirium and early mobilization protocols with more propofol (P = 0.001), dexmedetomidine (P = 0.001), and lower benzodiazepine dosing (P = 0.008). Conclusions: The implementation rate of ABCDE bundle components was very low in our Spanish setting, but when implemented, patients had a shorter ICU stay, more analgesia dosing, and lighter sedation. Relevance to clinical practice: Applying some but not all the bundle components, there is increased analgesia and light sedation drug use, decreased benzodiazepines, and increased patient cooperation and mobility, resulting in a shorter ICU stay and fewer days of IMV.
dc.description.departmentDepto. de Enfermería
dc.description.facultyFac. de Enfermería, Fisioterapia y Podología
dc.description.refereedTRUE
dc.description.sponsorshipEuropean Federation of Critical Care Nursing Associations (EfCCNa)
dc.description.sponsorshipSociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC)
dc.description.statuspub
dc.eprint.idhttps://eprints.ucm.es/id/eprint/70246
dc.identifier.doi10.1111/nicc.12740
dc.identifier.issn1362-1017
dc.identifier.officialurlhttps://doi.org/10.1111/nicc.12740
dc.identifier.urihttps://hdl.handle.net/20.500.14352/71293
dc.journal.titleNursing in Critical Care
dc.language.isoeng
dc.publisherWiley
dc.rightsAtribución-NoComercial-SinDerivadas 3.0 España
dc.rights.accessRightsopen access
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/3.0/es/
dc.subject.keyworddelirium
dc.subject.keywordearly mobilization
dc.subject.keywordmechanical ventilation
dc.subject.keywordpain assessment
dc.subject.keywordsedation
dc.subject.ucmEnfermería
dc.subject.unesco32 Ciencias Médicas
dc.titleThe impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study
dc.typejournal article
dspace.entity.typePublication
relation.isAuthorOfPublication90e233fb-d1b4-42ee-b9d7-ffc42e344eab
relation.isAuthorOfPublication61989576-46c1-456c-bca0-73cd8e2581a3
relation.isAuthorOfPublication69241230-f76c-4c30-9b5b-cb55442d5291
relation.isAuthorOfPublication.latestForDiscovery90e233fb-d1b4-42ee-b9d7-ffc42e344eab
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