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The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families

Ely, E. Wesley MD, MPH, FCCM

doi: 10.1097/CCM.0000000000002175
Plenary Articles
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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 postintensive care syndrome.” Patients with postintensive care syndrome 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 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 the implementation of the pain, agitation, and delirium 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 doing so, patients are “liberated” from iatrogenic aspects of care that threaten his or her sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th Society of Critical Care Medicine 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, quality improvement program is novel, generalizable, and practice changing.

Department of Medicine, Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN.

Dr. Ely received grants AG 027472, AG035117, and HL111111 from the National Institutes of Health for his time working on this article. Dr. Ely would additionally like to acknowledge salary support from the Tennessee Valley Veteran’s Affairs Healthcare System Geriatric Research Education and Clinical Center.

For information regarding this article, E-mail: wes.ely@vanderbilt.edu

Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.