Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults

作者：Brenda T. Pun, Michele C. Balas, Mary Ann Barnes‐Daly, Jennifer L. Thompson, Janet Aldrich, Juliana Barr, Diane Byrum, Shannon S. Carson, John W. Devlin, Heidi J. Engel, Cheryl L. Esbrook, Ken Hargett, Lori Harmon, Christina Hielsberg, James C. Jackson, Tamra Kelly, Vishakha K. Kumar, Lawson Millner, Alexandra Morse, Christiane Perme, Patricia J. Posa, Kathleen Puntillo, William D. Schweickert, Joanna L. Stollings, Alai Tan, Lucy D’Agostino McGowan, E. Wesley Ely · 发表于：Critical Care Medicine · 年份：2018 · DOI：10.1097/ccm.0000000000003482 · 被引用次数：1104 · 研究领域：Healthcare Decision-Making and Restraints、Intensive Care Unit Cognitive Disorders、Palliative Care and End-of-Life Issues

OBJECTIVE: Decades-old, common ICU practices including deep sedation, immobilization, and limited family access are being challenged. We endeavoured to evaluate the relationship between ABCDEF bundle performance and patient-centered outcomes in critical care. DESIGN: Prospective, multicenter, cohort study from a national quality improvement collaborative. SETTING: 68 academic, community, and federal ICUs collected data during a 20-month period. PATIENTS: 15,226 adults with at least one ICU day. INTERVENTIONS: We defined ABCDEF bundle performance (our main exposure) in two ways: 1) complete performance (patient received every eligible bundle element on any given day) and 2) proportional performance (percentage of eligible bundle elements performed on any given day). We explored the association between complete and proportional ABCDEF bundle performance and three sets of outcomes: patient-related (mortality, ICU and hospital discharge), symptom-related (mechanical ventilation, coma, delirium, pain, restraint use), and system-related (ICU readmission, discharge destination). All models were adjusted for a minimum of 18 a priori determined potential confounders. MEASUREMENTS AND RESULTS: Complete ABCDEF bundle performance was associated with lower likelihood of seven outcomes: hospital death within 7 days (adjusted hazard ratio, 0.32; CI, 0.17-0.62), next-day mechanical ventilation (adjusted odds ratio [AOR], 0.28; CI, 0.22-0.36), coma (AOR, 0.35; CI, 0.22-0.56), delirium (AOR, 0...