Table 4.
ABCDEF bundle performance
| Performance of ABCDEF bundle on days eligible for assessment (n/N [%])* | Performance of ABCDEF bundle on all study days (n=27 022) | ||
|---|---|---|---|
| Element A (assess, prevent, and manage pain) | 19 827/27 022 (73·4%) | 19 827 (73·4%) | |
| Element B | |||
| Spontaneous awakening trial | 5165/21 699 (23·8%) | 5165 (19·1%) | |
| Spontaneous breathing trial | 5174/22 687 (22·8%) | 5174 (19·1%) | |
| Element C | |||
| Assessment of sedation-agitation | 26 501/27 022 (98·1%) | 26 501 (98·1%) | |
| Avoidance of benzodiazepine† | 11 892/22 687 (52·4%) | 11 892 (44·0%) | |
| Element D (assess, prevent, and manage delirium) | 11 044/13 330 (82·9%) | 11 044 (40·9%) | |
| Element E (early mobility and exercise) | 4519/13 330 (33·9%) | 4519 (16·7%) | |
| Element F (family engagement and empowerment) | 4599/27 022 (17·0%) | 4599 (17·0%) | |
| In-person visitation with family or friends | 2192/27 022 (8·1%) | 2192 (8·1%) | |
| Virtual visitation only with family or friends | 2407/27 022 (8·9%) | 2407 (8·9%) | |
n/N (%)=days performed/eligible days. Daily performance of the ABCDEF bundle is shown for all cumulative ICU days for 2075 patients for a total of 27 022 days (13 patients who were only in the ICU for 1 day were excluded). Day of ICU discharge and day of death were not included. ICU=intensive care unit.
Daily performance criteria for each bundle element was defined as follows: element A, at least one pain assessment completed on all available days; element B, a spontaneous awakening trial (ie, daily sedation cessation) was done on days when patients were receiving continuous infusions, and a spontaneous breathing trial was done on days when patients were receiving invasive mechanical ventilation (eligible days included days when patients were on mechanical ventilation and might not have passed safety screen for a spontaneous awakening or breathing trial); element C, at least one agitation-sedation assessment completed on all available days; element D, at least one delirium assessment completed on all days when patients were not in a coma; element E, any exercise or mobility (ie, active range of motion, sit on edge of bed, stand, walk) occurred on all days when patients were not in a coma; element F, in-person visit or virtual connection via an electronic device (eg, cell phone, tablet, or laptop) with family or friends on all available days.
An additional criterion was added for the C element of the bundle for this study: number of days that benzodiazepines were avoided when patients were on invasive mechanical ventilation; clinical practice guidelines recommend avoiding this drug class for routine sedation management, however, this is not typically used to evaluate compliance or performance for this element of the bundle and thus was not included in the criteria used for our modelling.