RT Journal Article
T1 The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study
A1 Frade Mera, María Jesús
A1 Arias Rivera, Susana
A1 Zaragoza García, Ignacio
A1 Martí, Joan Daniel
A1 Gallart, Elisabet
A1 San José Arribas, Alicia
A1 Velasco Sanz, Tamara Raquel
A1 Blazquez Martínez, Eva
A1 Raurell Torredá, Marta
AB Background: 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.
PB Wiley
SN 1362-1017
YR 2022
FD 2022-01-06
LK https://hdl.handle.net/20.500.14352/71293
UL https://hdl.handle.net/20.500.14352/71293
LA eng
NO CRUE-CSIC (Acuerdos Transformativos 2021)
NO European Federation of Critical Care Nursing Associations (EfCCNa)
NO Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC)
DS Docta Complutense
RD 9 abr 2025