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Olsen, Keith; Burke, William; Peitz, Gregory; Gannon, David; Stothert, Joseph; Jawa, Randeep; Nuss, Suzanne; Thorell, William; Freihaut, Frank; Balas, Michele

doi: 10.1097/01.ccm.0000424261.88103.a9
Oral Abstract Session

University of Nebraska Medical Center

The Nebraska Medical Center

University of Nebraska Medical Center

The Nebraska Medical Center

University of Nebraska Medical Center


Introduction: Nearly two-thirds of patients admitted to an intensive care unit (ICU) develop delirium that results in longer stay, higher mortality, functional decline, and costs billions of dollars. In response, we implemented an interprofessional, evidence based delirium management strategy known as Awaking and Breathing Coordination, Delirium monitoring and management, and Early mobility (ABCDE) bundle into everyday clinical ICU care.

Hypothesis: To determine if the ABCDE bundle reduces the incidence of delirium in non-mechanically ventilated ICU patients.

Methods: This prospective study evaluated a group of non-ventilated ICU patients at baseline (Pre-ABCDE) and a similar group after the implementation of an institution wide ABCDE bundle (Post-ABCDE). The primary endpoint was the impact of the ABCDE bundle on patient outcomes that include the development of delirium and secondary endpoints of ICU and hospital LOS, total analgesic/antipsychotic/sedative medication dosing, time out of bed, hospital discharge disposition, and ICU and hospital mortality. In univariate analyses, statistical differences in continuous variables were tested using Wilcoxon rank sum test, while frequency of categorical variables were analyzed using Fisher’s exact test. P<0.05 was considered statistically significant.

Results: Baseline characteristic including APACHE II score, age, gender, comorbidity score, and sedative drugs prior to enrollment were similar between the 2 groups (Pre n=53 vs. Post ABCDE n=56). Patients experienced a lower incidence of derliurm at any time in the ICU [n=21 (39.6% vs. Post n=11 (19.6%); p=0.0221] and delirium days in the Post-ABCDE treatment group compared to the Pre-ABCDE group. The use of the CAM-ICU improved (0 to 60%) and the percentage of patients that were assisted out of bed significantly increased (49.1 vs. 75%; p=0.0052) in the post-ABCDE group despite no significant reduction in analgesic and sedative use.

Conclusions: Implementation of the ABCDE bundle reduces the overall incidence and duration of delirium in non-ventilated ICU patients.

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins