Improving Outcomes in Mechanically Ventilated Adult ICU Patients Following Implementation of the ICU Liberation (ABCDEF) Bundle Across a Large Healthcare System

被引：13

作者：

Barr, Juliana ^{[1
,2
]}

Downs, Brenda ^{[3
]}

Ferrell, Ken ^{[4
]}

Talebian, Mojdeh ^{[5
,6
]}

Robinson, Seth ^{[7
]}

Kolodisner, Liesl ^{[8
]}

Kendall, Heather ^{[9
]}

Holdych, Janet ^{[10
]}

机构：

[1] VA Palo Alto Hlth Care Syst, Anesthesiol & Perioperat Care Serv, Palo Alto, CA 94304 USA

[2] Stanford Univ, Sch Med, Dept Anesthesiol Perioperat & Pain Med, Stanford, CA USA

[3] CommonSpirit Hlth, Emergency Serv & Sepsis, Crit Care, Phoenix, AZ USA

[4] CommonSpirit Hlth, Data Sci, Phoenix, AZ USA

[5] CommonSpirit Hlth, Data Sci Dept, Phoenix, AZ USA

[6] Sequoia Hosp, Dign Hlth, ICU & Pulm Serv, Redwood City, CA USA

[7] Woodland Mem Hosp, ICU, Dign Hlth, Woodland, CA USA

[8] CommonSpirit Hlth, Qual Reporting & Informat, Phoenix, AZ USA

[9] Gordon & Betty Moore Fdn Grants Care Management, Roseville, CA USA

[10] CommonSpirit Hlth, Acute Care Qual, Glendale, CA USA

来源：

CRITICAL CARE EXPLORATIONS | 2024年 / 6卷 / 01期

关键词：

ABCDEF Bundle; critical care outcomes; intensive care unit liberation; implementation science; intensive care; quality improvement; EARLY EXERCISE/MOBILITY BUNDLE; PAIN OBSERVATION TOOL; DELIRIUM MONITORING/MANAGEMENT; BREATHING COORDINATION; EARLY MOBILITY; EARLY MOBILIZATION; CRITICAL ILLNESS; GUIDELINES; AGITATION; BARRIERS;

D O I：

10.1097/CCE.0000000000001001

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

OBJECTIVES: To measure how the ICU Liberation Bundle (aka ABCDEF Bundle or the Bundle) affected clinical outcomes in mechanically ventilated (MV) adult ICU patients, as well as bundle sustainability and spread across a healthcare system. DESIGN: We conducted a multicenter, prospective, cohort observational study to measure bundle performance versus patient outcomes and sustainability in 11 adult ICUs at six community hospitals. We then prospectively measured bundle spread and performance across the other 28 hospitals of the healthcare system. SETTING: A large community-based healthcare system. PATIENTS: In 11 study ICUs, we enrolled 1,914 MV patients (baseline n = 925, bundle performance/outcomes n = 989), 3,019 non-MV patients (baseline n = 1,323, bundle performance/outcomes n = 1,696), and 2,332 MV patients (bundle sustainability). We enrolled 9,717 MV ICU patients in the other 28 hospitals to assess bundle spread. INTERVENTIONS:We used evidence-based strategies to implement the bundle in all 34 hospitals. MEASUREMENTS AND MAIN RESULTS: We compared outcomes for the 12-month baseline and bundle performance periods. Bundle implementation reduced ICU length of stay (LOS) by 0.5 days (p = 0.02), MV duration by 0.6 days (p = 0.01), and ICU LOS greater than or equal to 7 days by 18.1% (p < 0.01). Performance period bundle compliance was compared with the preceding 3-month baseline compliance period. Compliance with pain management and spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) remained high, and reintubation rates remained low. Sedation assessments increased (p < 0.01) and benzodiazepine sedation use decreased (p < 0.01). Delirium assessments increased (p = 0.02) and delirium prevalence decreased (p = 0.02). Patient mobilization and ICU family engagement did not significantly improve. Bundle element sustainability varied. SAT/SBT compliance dropped by nearly half, benzodiazepine use remained low, sedation and delirium monitoring and management remained high, and patient mobility and family engagement remained low. Bundle compliance in ICUs across the healthcare system exceeded that of study ICUs. CONCLUSIONS: The ICU Liberation Bundle improves outcomes in MV adult ICU patients. Evidence-based implementation strategies improve bundle performance, spread, and sustainability across large healthcare systems.

引用

页数：13

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