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ABCDE Bundle Reduces Ventilation, Delirium

Nancy A. Melville

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

Without ABCDE Outcome (n = 93) Received a spontaneous awakening trial Received a spontaneous breathing trial Got out of bed at least once Days spent breathing without ventilator Experienced delirium Length of delirium Died in the intensive care unit Self-extubated 53% 71% 47% 21 days 75% 2 days 25.8% 6.5%

With ABCDE P Value (n = 94) 71% 84% 61% 24 days 66% 1 day 14.9% 5.3% .0372 .0290 .0675 .0371 .1623 .00437 .0913 .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.