abcde bundle reduces ventilation, delirium
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7/29/2019 ABCDE Bundle Reduces Ventilation, Delirium
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www.medscape.com
Jan 22, 2013
SAN JUAN, Puerto Rico Critically ill patients treated with the ABCDE bundle experience more days breathing without
assistance and less delirium, according to research presented here at the Society of Critical Care Medicine 42nd Critical Care
Congress.
The ABCDE bundle, first developed at Vanderbilt University in Nashville, Tennessee, incorporates interdisciplinary and
multicomponent approaches to critical care.
It encourages awakening trials for ventilated patients, spontaneous breathing tests, coordination between care providers
(including registered nurses and respiratory therapists), a standardized delirium assessment program, and early mobilization and
ambulation.
The ABCDE bundle is a rational and evidenced-based way to manage sick, mechanically ventilated patients.
"There have been numerous studies looking at the variables, such as the benefits of cutting back on sedation and even letting
people breath on their own once a day, every day," said lead author Michele Balas, PhD, RN, from the University of Nebraska
Medical Center in Omaha. "We have found over the last 5 years that very aggressive early mobilization is especially effective in
reducing the incidence and duration of delirium, but this is the first study demonstrating the outcome if you put all of these things
together," she explained.
To assess the bundle's effectiveness, Dr. Balas and her team compared the outcomes of 186 critically ill patients. They were
divided into 2 groups: those treated with traditional care and those treated with the ABCDE bundle approach.
Although baseline characteristics, including age, severity of illness, and sedative drug use, were similar in the 2 groups, patients
in the ABCDE group spent more days breathing without ventilator assistance. In addition, rates of delirium and mortality in the
intensive care unit were lower in the ABCDE group than in the traditional-care group.
Effect of ABCDE Bundle on Patient Outcomes
Outcome
Without ABCDE
(n= 93)
With ABCDE
(n= 94)
PValue
Received a spontaneous awakening trial 53% 71% .0372
Received a spontaneous breathing trial 71% 84% .0290
Got out of bed at least once 47% 61% .0675
Days spent breathing without ventilator 21 days 24 days .0371
Experienced delirium 75% 66% .1623
Length of delirium 2 days 1 day .00437
Died in the intensive care unit 25.8% 14.9% .0913
Self-extubated 6.5% 5.3% .7421
One patient in each group self-extubated and later required reintubation. There were no significant differences between groups
in terms of time to intensive care or hospital discharge, incidence or duration of coma, or change in residence.
ABCDE Bundle Reduces Ventilation, DeliriumNancy A. Melville