TY - JOUR
T1 - Worldwide Survey of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment" (ABCDEF) Bundle
AU - Morandi, Alessandro
AU - Piva, Simone
AU - Ely, E. Wesley
AU - Myatra, Sheila Nainan
AU - Salluh, Jorge I.F.
AU - Amare, Dawit
AU - Azoulay, Elie
AU - Bellelli, Giuseppe
AU - Csomos, Akos
AU - Fan, Eddy
AU - Fagoni, Nazzareno
AU - Girard, Timothy D.
AU - Heras La Calle, Gabriel
AU - Inoue, Shigeaki
AU - Lim, Chae Man
AU - Kaps, Rafael
AU - Kotfis, Katarzyna
AU - Koh, Younsuck
AU - Misango, David
AU - Pandharipande, Pratik P.
AU - Permpikul, Chairat
AU - Cheng Tan, Cheng
AU - Wang, Dong Xin
AU - Sharshar, Tarek
AU - Shehabi, Yahya
AU - Skrobik, Yoanna
AU - Singh, Jeffrey M.
AU - Slooter, Arjen
AU - Smith, Martin
AU - Tsuruta, Ryosuke
AU - Latronico, Nicola
PY - 2017/11/1
Y1 - 2017/11/1
N2 - OBJECTIVES: To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines.DESIGN: Worldwide online survey.SETTING: Intensive care.INTERVENTION: A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle.MEASUREMENT AND MAIN RESULTS: There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was "prescribed" by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits.CONCLUSIONS: The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.
AB - OBJECTIVES: To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines.DESIGN: Worldwide online survey.SETTING: Intensive care.INTERVENTION: A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle.MEASUREMENT AND MAIN RESULTS: There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was "prescribed" by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits.CONCLUSIONS: The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.
UR - http://www.scopus.com/inward/record.url?scp=85032143166&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000002640
DO - 10.1097/CCM.0000000000002640
M3 - Article
C2 - 28787293
AN - SCOPUS:85032143166
SN - 0090-3493
VL - 45
SP - e1111-e1122
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 11
ER -