Effects of the ABCDE bundle on the prevention of post‐intensive care syndrome: A retrospective study

Aim To identify the effects of each domain of the early and modified ABCDE bundle on post‐intensive care syndrome (PICS). Design This is a retrospective study. Methods We analysed the data from electronic medical records of 91 intensive care patients who received therapeutic interventions in stages, based on the early ABCDE bundle (admitted to the intensive care unit [ICU] from June – August 2013) and 94 patients who received interventions using a modified ABCDE bundle developed through continuous quality improvement activities (admitted to the ICU from June to August 2014). Results In the ABC domain, the percentage of patients showing sedation levels of alertness and calmness increased significantly from 58.2% using the early ABCDE bundle to 72.4% using the modified ABCDE bundle. Coma prevalence decreased significantly from 45.1% using the early ABCDE bundle to 28.7% using the modified ABCDE bundle. In the E domain, the percentage of patients receiving early mobility interventions increased significantly from 11% using the early ABCDE bundle to 54.3% using the modified ABCDE bundle. Conclusion The ABCDE bundle in the ICU helped prevent PICS by reducing deep sedation and immobilization among intensive care patients. To effectively use the ABCDE bundle, it is necessary for institutions to develop suitable protocols for each constituent element and to test their effectiveness. Impact The ABCDE bundle was a suitable tool to support evidence‐based practice in intensive care patients, including oversedation and immobilization, which is related to the prevention of PICS. Individual institutions will need to actively use the ABCDE bundle in the ICU, by developing protocols and testing their effectiveness. 目的 确定早期和改良ABCDE集束化措施各区域对重症监护后综合征(PICS)的影响。 设计 本研究为回顾性研究。 方法 我们对基于早期ABCDE集束化措施的91例分期接受治疗干预的重症监护患者(2013年6月至8月入住重症监护室【ICU】的患者),以及对使用通过持续质量改进活动来开发改良的ABCDE集束化措施接受干预的94名患者(2014年6月至8月入住ICU的患者)的电子病历资料进行分析。 结果 在ABC区,针对镇静和警觉水平的患者比例从早期使用ABCDE集束化措施的58.2%显著增加到使用改良ABCDE集束化措施的72.4%。昏迷发生率从早期使用ABCDE集束化措施的45.1%显著下降到使用改良ABCDE集束化措施的28.7%。在E区,接受早期活动性干预的患者百分比从早期使用ABCDE集束化措施的11%显著增加到使用改良ABCDE集束化措施的54.3%。 结论 重症监护室内采用ABCDE集束化措施可减轻重症监护患者的过度镇静和无法活动情况,有助于预防重症监护后综合症的发生。为有效地使用ABCDE集束化措施,各医疗机构须为每个组成部分制定适当方案,并检验其有效性。 影响 ABCDE集束化措施是支持重症监护患者循证实践的适当工具,包括过度镇静和无法活动情况,有助于预防重症监护后综合症的发生。各医疗机构将需通过制定方案并检验其有效性,在重症监护室中广泛使用ABCDE集束化措施。