Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle*
Top Cited Papers
- 1 May 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 42 (5), 1024-1036
- https://doi.org/10.1097/ccm.0000000000000129
Abstract
Objective: The debilitating and persistent effects of ICU-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle into everyday practice. Design: Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012. Setting: Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center. Patients: Two hundred ninety-six patients (146 prebundle and 150 postbundle implementation), who are 19 years old or older, managed by the institutions’ medical or surgical critical care service. Interventions: Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle. Measurements and Main Results: For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Patients in the postimplementation period spent three more days breathing without mechanical assistance than did those in the preimplementation period (median [interquartile range], 24 [7–26] vs 21 [0–25]; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle experienced a near halving of the odds of delirium (odds ratio, 0.55; 95% CI, 0.33–0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (odds ratio, 2.11; 95% CI, 1.29–3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates. Conclusions: Critically ill patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care.This publication has 47 references indexed in Scilit:
- A Combined Early Cognitive and Physical Rehabilitation Program for People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) TrialPTJ: Physical Therapy & Rehabilitation Journal, 2012
- A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivorsCritical Care Medicine, 2010
- Delirium as a predictor of long-term cognitive impairment in survivors of critical illnessCritical Care Medicine, 2010
- Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit PopulationAmerican Journal of Respiratory and Critical Care Medicine, 2009
- Outcomes Associated With Delirium in Older Patients in Surgical ICUsSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2009
- Risk factors for delirium in intensive care patients: a prospective cohort studyCritical Care, 2009
- Delirium in the intensive care unitCritical Care, 2008
- Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care UnitJAMA, 2004
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- APACHE IICritical Care Medicine, 1985