The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families.
The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families.
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DOI：
10.1097/ccm.0000000000002175
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发表时间：
2017-03
影响因子：
8.8
通讯作者：
Ely EW
中科院分区：
文献类型：
--
作者：
Ely EW
在过去的20年里，重症监护已经以无数种方式成熟起来，从而大大提高了病情最严重的患者的存活率。对于数百万新的幸存者来说，他们会重新遭受痛苦和残疾，这被称为重症监护后综合症（PICS）。PICS患者被剥夺了正常的认知、情感和身体能力，无法恢复以前的生活。ICU解放协作是一项在76个ICU中实施的现实世界质量改进（QI）倡议，旨在通过团队和循证护理战略性地参与ABCDEF捆绑。本文解释了将ICU患者和家属从危重疾病和医源性伤害中解放出来的科学和哲学。ICU解放是一个广泛的项目，旨在促进实施疼痛、躁动和谵妄（PAD）指南，使用循证ABCDEF Bundle。参与的ICU团队采用了数百项同行评审研究的数据，以实施一种系统可靠的方法，将ICU文化从镇静和约束的有害惯性转变为充满活力的ICU，其中充满了清醒，认知参与，活动的患者，以及作为ICU团队床边合作伙伴的家庭成员。这样，病人就可以从威胁其自我价值感和人类尊严的医源性护理中解脱出来。2017年第47届SCCM大会全体演讲的目标是为临床ICU团队提供导致ICU解放理念创建的文献综合，并解释这个以患者和家庭为中心的QI计划是如何新颖，可推广和改变实践的。
Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called the Post-Intensive Care Syndrome (PICS). Patients with PICS are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement (QI) initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care. This article explains the science and philosophy of liberating ICU patients and families from harm that is both inherent to critical illness and iatrogenic. ICU Liberation is an extensive program designed to facilitate implementation of the Pain, Agitation, and Delirium (PAD) guidelines, using the evidence-based ABCDEF Bundle. Participating ICU teams adapt data from hundreds of peer-reviewed studies to operationalize a systematic and reliable methodology that shifts ICU culture from the harmful inertia of sedation and restraints to an animated ICU filled with patients who are awake, cognitively engaged, and mobile with family members engaged as partners with the ICU team at the bedside. In so doing, patients are liberated from iatrogenic aspects of care that threaten her or his sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th SCCM Congress is to provide clinical ICU teams a synthesis of the literature that led to the creation of ICU Liberation philosophy and to explain how this patient- and family-centered, QI program is novel, generalizable, and practice-changing.