Bundle Element		Evidence
A	Assess, Prevent, and Manage Pain	Pain is a common memory of ICU survivors86,87 and increases risk for post-traumatic stress disorder19,20. When pain is routinely assess using a validated pain scale and controlled with intravenous narcotics, sedation can often be avoided87,88,40.
B	Both Spontaneous Awakening and Spontaneous Breathing Trials	Spontaneous awakening and breathing trials are associated with shorter duration of mechanical ventilation, better psychological outcomes, and significantly improved 1-year mortality66,67,68.
C	Choice of Analgesia and Sedation	Non-benzodiazepine sedatives are associated with less delirium88,89, particularly in septic patients. In general, patients do better with less sedation89,90. Less sedation may be achieved by spontaneous awakening trials, bolus versus continuous sedation, and targeting a lighter depth of sedation89,90.
D	Delirium Monitoring and Management	Delirium is associated with greater mortality and cognitive impairment90,19,91. Screening for delirium with tools such as the Confusion Assessment Method for the ICU (CAM-ICU) can increase recognition of delirium91,92, prompting clinicians to address driving factors such as medications, environment and medical conditions.
E	Early Mobility and Exercise	Skeletal muscle wasting begins within 24 hours of critical illness56,57. Early mobility, including walking patients during invasive mechanical ventilation, has been shown to be safe and effective at reducing short-term physical disability associated with critical illness, as well as at reducing delirium53,54,54,55.
F	Family Engagement and Empowerment	Families are important supports for patients’ recovery, also experience poor outcomes related to ICU care62,63. Family presence on ICU rounds and open visiting hours are associated with improved satisfaction and communication65 65,66.