Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle.
Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle.
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DOI：
10.1097/ccm.0000000000000129
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发表时间：
2014-05
影响因子：
8.8
通讯作者：
Burke WJ
中科院分区：
文献类型：
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作者：
Balas MC;Vasilevskis EE;Olsen KM;Schmid KK;Shostrom V;Cohen MZ;Peitz G;Gannon DE;Sisson J;Sullivan J;Stothert JC;Lazure J;Nuss SL;Jawa RS;Freihaut F;Ely EW;Burke WJ
重症监护室（ICU）获得性谵妄和虚弱的衰弱和持续影响需要测试预防策略。本研究的目的是评估在日常实践中实施唤醒和呼吸协调、谵妄监测/管理和早期锻炼/活动（ABCDE）的有效性和安全性。2010年11月至2012年5月期间进行的为期18个月的前瞻性队列研究。五个成人ICU，一个降压单位，一个肿瘤/血液学特殊护理单位位于一个624张病床的三级医疗中心。296例患者（146例实施捆绑治疗前和150例实施捆绑治疗后），年龄≥ 19岁，由医疗机构的内科或外科重症监护服务管理。ABCDE捆绑包。对于机械通气患者（n = 187），我们研究了捆绑实施和无呼吸机天数之间的相关性。对于所有患者，我们使用回归模型来量化ABCDE捆绑实施与谵妄和昏迷的患病率/持续时间、早期动员、死亡率、出院时间和居住地变化之间的关系。监测安全性结局和捆绑依从性。实施后阶段的患者在没有机械辅助的情况下呼吸的时间比实施前阶段的患者多三天（中位数[IQR]，24 [7至26] vs. 21 [0至25]; p = 0.04）。在调整了年龄、性别、疾病严重程度、合并症和机械通气状态后，ABCDE捆绑治疗的患者发生谵妄的几率几乎减半。（比值比[OR]，0.55; 95%置信区间[CI]，0.33-0.93; p = 0.03）和ICU住院期间至少一次下床活动的几率增加（OR，2.11; 95% CI，1.29-3.45; p = 0.003）。自行拔管或重新插管率无显著差异。与接受常规护理的患者相比，接受ABCDE捆绑治疗的重症患者在没有辅助的情况下多呼吸了三天，经历了更少的谵妄，并且在ICU住院期间更有可能被动员。
The debilitating and persistent effects of intensive care unit (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 (ABCDE) bundle into everyday practice. Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012. Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center. Two hundred ninety-six patients (146 pre- and 150 post-bundle implementation), age ≥ 19 years, managed by the institutions’ medical or surgical critical care service. ABCDE bundle. 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 ABCDE 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 post-implementation period spent three more days breathing without mechanical assistance than did those in the pre-implementation period (median [IQR], 24 [7 to 26] vs. 21 [0 to 25]; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the ABCDE bundle experienced a near halving of the odds of delirium (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.33–0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (OR, 2.11; 95% CI, 1.29–3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates. Critically ill patients managed with the ABCDE 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.