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Worldwide Survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment” (ABCDEF) Bundle

Morandi, Alessandro MD, MPH; Piva, Simone MD; Ely, E. Wesley MD, MPH; Myatra, Sheila Nainan MD, FCCM, FICCM; Salluh, Jorge I.F. MD, PhD; Amare, Dawit MD; Azoulay, Elie MD, PhD; Bellelli, Giuseppe MD; Csomos, Akos MD, PhD; Fan, Eddy MD, PhD; Fagoni, Nazzareno MD,PhD; Girard, Timothy D. MD, MSCI; Heras La Calle, Gabriel MD; Inoue, Shigeaki MD, PhD, MSCI; Lim, Chae-Man MD, PhD, FCCM; Kaps, Rafael MD; Kotfis, Katarzyna MD, PhD; Koh, Younsuck MD; Misango, David MD; Pandharipande, Pratik P. MD, MSCI; Permpikul, Chairat MD; Cheng Tan, Cheng MD, PhD; Wang, Dong-Xin MD, PhD; Sharshar, Tarek MD, PhD; Shehabi, Yahya PhD, FCICM, FANZCA, EMBA; Skrobik, Yoanna MD, FRCP(c) MSc, FCCM; Singh, Jeffrey M. MD; Slooter, Arjen MD, PhD; Smith, Martin MBBS, FRCA, FFICM; Tsuruta, Ryosuke MD, PhD; Latronico, Nicola MD
doi: 10.1097/CCM.0000000000002640
Online Clinical Investigation: PDF Only

Objectives: To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines.

Design: Worldwide online survey.

Setting: Intensive care.

Intervention: A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle.

Measurement and Main Results: There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was “prescribed” by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits.

Conclusions: The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.

All authors contributed in study conception; design and critically revised the article; and interpretation of results. Drs. Morandi and Piva have equally contributed as first authors to the article and drafted the article and in acquisition of data.

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