ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study

Keibun Liu; Kensuke Nakamura; Hajime Katsukawa; Muhammed Elhadi; Peter Nydahl; Eugene Wesley Ely; Sapna R Kudchadkar; Kunihiko Takahashi; Shigeaki Inoue; Alan Kawarai Lefor; Jozef Kesecioglu; Osamu Nishida

doi:10.1097/CCE.0000000000000353

ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study

Keibun Liu, Kensuke Nakamura, Hajime Katsukawa, Muhammed Elhadi, Peter Nydahl, Eugene Wesley Ely, Sapna R Kudchadkar, Kunihiko Takahashi, Shigeaki Inoue, Alan Kawarai Lefor, Jozef Kesecioglu, Osamu Nishida

Research output: Contribution to journal › Article › Academic › peer-review

10 Downloads (Pure)

Abstract

Objectives: To investigate implementation of evidence-based and supportive cares in ICUs, such as the ABCDEF, nutrition therapy, and ICU diary, for patients with coronavirus disease 2019 infection in ICUs and their association with ICU clinical practice and setting.

Design: A worldwide, 2-day point prevalence study.

Setting: The study was carried out on June 3, 2020, and July 1, 2020. A total of 212 ICUs in 38 countries participated. Clinicians in each participating ICU completed web-based online surveys.

Patients: The ICU patients with coronavirus disease 2019.

Interventions: None.

Measurements and Main results: The implementation rate for the elements of the ABCDEF bundle, other supportive ICU care measures, and implementation-associated structures were investigated. Data were collected for 262 patients, of whom 47.3% underwent mechanical ventilation and 4.6% were treated with extracorporeal membrane oxygenation. Each element was implemented for the following percentages of patients: elements A (regular pain assessment), 45%; B (both spontaneous awakening and breathing trials), 28%; C (regular sedation assessment), 52%; D (regular delirium assessment), 35%; E (early mobility and exercise), 47%; and F (family engagement and empowerment), 16%. The implementation of element E was 4% for patients on mechanical ventilation and 8% for patients on extracorporeal membrane oxygenation. Supportive care, such as protein provision throughout the ICU stay (under 1.2 g/kg for more than 50% of the patients) and introduction of ICU diary (25%), was infrequent. Implementation rates of elements A and D were higher in ICUs with specific protocols and fewer ICU beds exclusively for patients with coronavirus disease 2019 infection. Element E was implemented at a higher rate in ICUs that had more ICU beds assigned for them.

Conclusions: This point prevalence study showed low implementation of the ABCDEF bundle. Specific protocols and the number of ICU beds reserved for patients with coronavirus disease 2019 infection might be key factors for delivering appropriate supportive care.

Original language	English
Article number	e0353
Pages (from-to)	1-16
Journal	Critical care explorations
Volume	3
Issue number	3
DOIs	https://doi.org/10.1097/CCE.0000000000000353
Publication status	Published - Mar 2021

Keywords

intensive care unit liberation bundle
novel coronavirus
pandemic
postintensive care syndrome
quality improvement
supportive care

Access to Document

10.1097/CCE.0000000000000353Licence: CC BY-NC-ND

ABCDEF_Bundle_and_Supportive_ICU_Practices_for.12Final published version, 959 KBLicence: CC BY-NC-ND

Cite this

Liu, K., Nakamura, K., Katsukawa, H., Elhadi, M., Nydahl, P., Ely, E. W., Kudchadkar, S. R., Takahashi, K., Inoue, S., Lefor, A. K., Kesecioglu, J., & Nishida, O. (2021). ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study. Critical care explorations, 3(3), 1-16. Article e0353. https://doi.org/10.1097/CCE.0000000000000353

@article{031d4fd0602c43e6a80a886052c6875a,

title = "ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study",

abstract = "Objectives: To investigate implementation of evidence-based and supportive cares in ICUs, such as the ABCDEF, nutrition therapy, and ICU diary, for patients with coronavirus disease 2019 infection in ICUs and their association with ICU clinical practice and setting.Design: A worldwide, 2-day point prevalence study.Setting: The study was carried out on June 3, 2020, and July 1, 2020. A total of 212 ICUs in 38 countries participated. Clinicians in each participating ICU completed web-based online surveys.Patients: The ICU patients with coronavirus disease 2019.Interventions: None.Measurements and Main results: The implementation rate for the elements of the ABCDEF bundle, other supportive ICU care measures, and implementation-associated structures were investigated. Data were collected for 262 patients, of whom 47.3% underwent mechanical ventilation and 4.6% were treated with extracorporeal membrane oxygenation. Each element was implemented for the following percentages of patients: elements A (regular pain assessment), 45%; B (both spontaneous awakening and breathing trials), 28%; C (regular sedation assessment), 52%; D (regular delirium assessment), 35%; E (early mobility and exercise), 47%; and F (family engagement and empowerment), 16%. The implementation of element E was 4% for patients on mechanical ventilation and 8% for patients on extracorporeal membrane oxygenation. Supportive care, such as protein provision throughout the ICU stay (under 1.2 g/kg for more than 50% of the patients) and introduction of ICU diary (25%), was infrequent. Implementation rates of elements A and D were higher in ICUs with specific protocols and fewer ICU beds exclusively for patients with coronavirus disease 2019 infection. Element E was implemented at a higher rate in ICUs that had more ICU beds assigned for them.Conclusions: This point prevalence study showed low implementation of the ABCDEF bundle. Specific protocols and the number of ICU beds reserved for patients with coronavirus disease 2019 infection might be key factors for delivering appropriate supportive care.",

keywords = "intensive care unit liberation bundle, novel coronavirus, pandemic, postintensive care syndrome, quality improvement, supportive care",

author = "Keibun Liu and Kensuke Nakamura and Hajime Katsukawa and Muhammed Elhadi and Peter Nydahl and Ely, {Eugene Wesley} and Kudchadkar, {Sapna R} and Kunihiko Takahashi and Shigeaki Inoue and Lefor, {Alan Kawarai} and Jozef Kesecioglu and Osamu Nishida",

year = "2021",

month = mar,

doi = "10.1097/CCE.0000000000000353",

language = "English",

volume = "3",

pages = "1--16",

number = "3",

}

Liu, K, Nakamura, K, Katsukawa, H, Elhadi, M, Nydahl, P, Ely, EW, Kudchadkar, SR, Takahashi, K, Inoue, S, Lefor, AK, Kesecioglu, J & Nishida, O 2021, 'ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study', Critical care explorations, vol. 3, no. 3, e0353, pp. 1-16. https://doi.org/10.1097/CCE.0000000000000353

TY - JOUR

T1 - ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection

T2 - An International Point Prevalence Study

AU - Liu, Keibun

AU - Nakamura, Kensuke

AU - Katsukawa, Hajime

AU - Elhadi, Muhammed

AU - Nydahl, Peter

AU - Ely, Eugene Wesley

AU - Kudchadkar, Sapna R

AU - Takahashi, Kunihiko

AU - Inoue, Shigeaki

AU - Lefor, Alan Kawarai

AU - Kesecioglu, Jozef

AU - Nishida, Osamu

PY - 2021/3

Y1 - 2021/3

N2 - Objectives: To investigate implementation of evidence-based and supportive cares in ICUs, such as the ABCDEF, nutrition therapy, and ICU diary, for patients with coronavirus disease 2019 infection in ICUs and their association with ICU clinical practice and setting.Design: A worldwide, 2-day point prevalence study.Setting: The study was carried out on June 3, 2020, and July 1, 2020. A total of 212 ICUs in 38 countries participated. Clinicians in each participating ICU completed web-based online surveys.Patients: The ICU patients with coronavirus disease 2019.Interventions: None.Measurements and Main results: The implementation rate for the elements of the ABCDEF bundle, other supportive ICU care measures, and implementation-associated structures were investigated. Data were collected for 262 patients, of whom 47.3% underwent mechanical ventilation and 4.6% were treated with extracorporeal membrane oxygenation. Each element was implemented for the following percentages of patients: elements A (regular pain assessment), 45%; B (both spontaneous awakening and breathing trials), 28%; C (regular sedation assessment), 52%; D (regular delirium assessment), 35%; E (early mobility and exercise), 47%; and F (family engagement and empowerment), 16%. The implementation of element E was 4% for patients on mechanical ventilation and 8% for patients on extracorporeal membrane oxygenation. Supportive care, such as protein provision throughout the ICU stay (under 1.2 g/kg for more than 50% of the patients) and introduction of ICU diary (25%), was infrequent. Implementation rates of elements A and D were higher in ICUs with specific protocols and fewer ICU beds exclusively for patients with coronavirus disease 2019 infection. Element E was implemented at a higher rate in ICUs that had more ICU beds assigned for them.Conclusions: This point prevalence study showed low implementation of the ABCDEF bundle. Specific protocols and the number of ICU beds reserved for patients with coronavirus disease 2019 infection might be key factors for delivering appropriate supportive care.

AB - Objectives: To investigate implementation of evidence-based and supportive cares in ICUs, such as the ABCDEF, nutrition therapy, and ICU diary, for patients with coronavirus disease 2019 infection in ICUs and their association with ICU clinical practice and setting.Design: A worldwide, 2-day point prevalence study.Setting: The study was carried out on June 3, 2020, and July 1, 2020. A total of 212 ICUs in 38 countries participated. Clinicians in each participating ICU completed web-based online surveys.Patients: The ICU patients with coronavirus disease 2019.Interventions: None.Measurements and Main results: The implementation rate for the elements of the ABCDEF bundle, other supportive ICU care measures, and implementation-associated structures were investigated. Data were collected for 262 patients, of whom 47.3% underwent mechanical ventilation and 4.6% were treated with extracorporeal membrane oxygenation. Each element was implemented for the following percentages of patients: elements A (regular pain assessment), 45%; B (both spontaneous awakening and breathing trials), 28%; C (regular sedation assessment), 52%; D (regular delirium assessment), 35%; E (early mobility and exercise), 47%; and F (family engagement and empowerment), 16%. The implementation of element E was 4% for patients on mechanical ventilation and 8% for patients on extracorporeal membrane oxygenation. Supportive care, such as protein provision throughout the ICU stay (under 1.2 g/kg for more than 50% of the patients) and introduction of ICU diary (25%), was infrequent. Implementation rates of elements A and D were higher in ICUs with specific protocols and fewer ICU beds exclusively for patients with coronavirus disease 2019 infection. Element E was implemented at a higher rate in ICUs that had more ICU beds assigned for them.Conclusions: This point prevalence study showed low implementation of the ABCDEF bundle. Specific protocols and the number of ICU beds reserved for patients with coronavirus disease 2019 infection might be key factors for delivering appropriate supportive care.

KW - intensive care unit liberation bundle

KW - novel coronavirus

KW - pandemic

KW - postintensive care syndrome

KW - quality improvement

KW - supportive care

U2 - 10.1097/CCE.0000000000000353

DO - 10.1097/CCE.0000000000000353

M3 - Article

C2 - 33786432

SN - 2639-8028

VL - 3

SP - 1

EP - 16

JO - Critical care explorations

JF - Critical care explorations

IS - 3

M1 - e0353

ER -

ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study

Abstract

Keywords

Access to Document

Fingerprint

Cite this